Provider Demographics
NPI:1780198796
Name:LIN PLASTIC AND RECONSTRUCTIVE SURGERY INC
Entity Type:Organization
Organization Name:LIN PLASTIC AND RECONSTRUCTIVE SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PEY-YI
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-500-5135
Mailing Address - Street 1:730 W COUCH PL UNIT 1409
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-1383
Mailing Address - Country:US
Mailing Address - Phone:310-500-5135
Mailing Address - Fax:
Practice Address - Street 1:730 W COUCH PL UNIT 1409
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-1383
Practice Address - Country:US
Practice Address - Phone:310-500-5135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty