Provider Demographics
NPI:1508893496
Name:LIN, TESU (MD)
Entity Type:Individual
Prefix:
First Name:TESU
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-211 PALI MOMI ST STE 312
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4306
Mailing Address - Country:US
Mailing Address - Phone:808-486-0449
Mailing Address - Fax:808-756-9552
Practice Address - Street 1:98-211 PALI MOMI ST STE 312
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4306
Practice Address - Country:US
Practice Address - Phone:808-486-0449
Practice Address - Fax:808-756-9552
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-19780207RG0100X
CAG83685207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP1005OtherRR MEDICARE
796553Medicare UPIN
W4731Medicare ID - Type Unspecified