Provider Demographics
NPI:1679589816
Name:LIN, JUI-KUANG (MD)
Entity Type:Individual
Prefix:DR
First Name:JUI-KUANG
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 1:505 MARIGOLD AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-2408
Mailing Address - Country:US
Mailing Address - Phone:909-626-9922
Mailing Address - Fax:909-399-9494
Practice Address - Street 1:1211 W 6TH ST
Practice Address - Street 2:FOUR SEASON SURGERY CENTER
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-1103
Practice Address - Country:US
Practice Address - Phone:909-626-9922
Practice Address - Fax:909-399-9494
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31805207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A318050Medicare ID - Type Unspecified