Provider Demographics
NPI:1467831420
Name:BONNIE LIN DPM A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:BONNIE LIN DPM A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:714-628-1995
Mailing Address - Street 1:1439 W CHAPMAN AVE
Mailing Address - Street 2:250
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2738
Mailing Address - Country:US
Mailing Address - Phone:216-337-3636
Mailing Address - Fax:
Practice Address - Street 1:705 W LA VETA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4402
Practice Address - Country:US
Practice Address - Phone:714-628-1995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-23
Last Update Date:2015-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty