Provider Demographics
NPI:1689759276
Name:AUGUSTIN A. LIN, D.O., INC.
Entity Type:Organization
Organization Name:AUGUSTIN A. LIN, D.O., INC.
Other - Org Name:FAMILY SPECIALTY CARE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AUGUSTIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:909-396-1755
Mailing Address - Street 1:3817 GRAND AVE STE B
Mailing Address - Street 2:PMB 225
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5443
Mailing Address - Country:US
Mailing Address - Phone:909-396-1755
Mailing Address - Fax:909-396-8268
Practice Address - Street 1:13768 ROSWELL AVE
Practice Address - Street 2:SUITE #120
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-1401
Practice Address - Country:US
Practice Address - Phone:909-396-1755
Practice Address - Fax:909-396-8268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A6462OtherSTATE MEDICAL LICENSE