Provider Demographics
NPI:1609072446
Name:LYNN DIMINO MD INC.
Entity Type:Organization
Organization Name:LYNN DIMINO MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-721-8300
Mailing Address - Street 1:360 SAN MIGUEL DR
Mailing Address - Street 2:SUITE 603
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7853
Mailing Address - Country:US
Mailing Address - Phone:949-721-8300
Mailing Address - Fax:949-721-8833
Practice Address - Street 1:360 SAN MIGUEL DR
Practice Address - Street 2:SUITE 603
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7853
Practice Address - Country:US
Practice Address - Phone:949-721-8300
Practice Address - Fax:949-721-8833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71777207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1609072446OtherMEDICARE, BLUE SHIELD
CA1699724542OtherALL OTHER INSURANCES