Provider Demographics
NPI:1790858686
Name:LIN, SUN-CO (MD)
Entity Type:Individual
Prefix:DR
First Name:SUN-CO
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 1:13625 MAPLE AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3892
Mailing Address - Country:US
Mailing Address - Phone:718-463-0313
Mailing Address - Fax:
Practice Address - Street 1:13625 MAPLE AVE STE 210
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3892
Practice Address - Country:US
Practice Address - Phone:718-463-0313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170530207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01030533Medicaid
NY06238Medicare PIN
NY01030533Medicaid