Provider Demographics
NPI:1740380393
Name:LIN, HSIUNG W (MD)
Entity Type:Individual
Prefix:DR
First Name:HSIUNG
Middle Name:W
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 1:425 W MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-7439
Mailing Address - Country:US
Mailing Address - Phone:626-576-0586
Mailing Address - Fax:626-576-0569
Practice Address - Street 1:425 W MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-7439
Practice Address - Country:US
Practice Address - Phone:626-576-0586
Practice Address - Fax:626-576-0569
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36375207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A363751Medicaid
CA00A363751Medicaid
CAA36375Medicare PIN
CAA36375Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID