Provider Demographics
NPI:1619057429
Name:LIN, JAMES JD (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JD
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:340 W CENTRAL AVE
Mailing Address - Street 2:SUITE 122
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-3006
Mailing Address - Country:US
Mailing Address - Phone:714-529-8923
Mailing Address - Fax:714-529-7017
Practice Address - Street 1:340 W CENTRAL AVE
Practice Address - Street 2:SUITE 122
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3006
Practice Address - Country:US
Practice Address - Phone:714-529-8923
Practice Address - Fax:714-529-7017
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA30146207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE01598Medicare UPIN
CAA30146Medicare ID - Type Unspecified