Provider Demographics
NPI:1790895845
Name:LIN, CHANG TSAI (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANG
Middle Name:TSAI
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:360 E 7TH ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-6701
Mailing Address - Country:US
Mailing Address - Phone:909-985-1557
Mailing Address - Fax:909-985-2414
Practice Address - Street 1:360 E 7TH ST
Practice Address - Street 2:SUITE H
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6701
Practice Address - Country:US
Practice Address - Phone:909-985-1557
Practice Address - Fax:909-985-2414
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA29555208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A295550Medicaid
CA00A295550Medicaid