Provider Demographics
NPI:1689602609
Name:LIN, JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
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 1:17223 PARKVALLE AVE
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-1029
Mailing Address - Country:US
Mailing Address - Phone:562-623-4032
Mailing Address - Fax:562-404-7811
Practice Address - Street 1:1701 SANTA ANITA AVE
Practice Address - Street 2:
Practice Address - City:SOUTH EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-3482
Practice Address - Country:US
Practice Address - Phone:626-350-7957
Practice Address - Fax:626-448-0485
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77035207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G770350Medicaid
CAG35626Medicare UPIN
CA00G770350Medicaid
CAWG77035EMedicare PIN
CAWG77035DMedicare PIN