Provider Demographics
NPI:1710290002
Name:LIN, CHUANG-YUAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHUANG-YUAN
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 1:2650 RIDGE AVE STE 1223
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:847-982-6710
Mailing Address - Fax:847-982-3394
Practice Address - Street 1:2650 RIDGE AVE.
Practice Address - Street 2:EMERGENCY MEDICINE
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1718
Practice Address - Country:US
Practice Address - Phone:847-570-2114
Practice Address - Fax:847-570-1223
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036134549207P00000X
IL125.058700207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL125.058700OtherTEMPORARY MEDICAL LICENSE