Provider Demographics
NPI:1851326557
Name:LIN, DAVID SU-SIEN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SU-SIEN
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:PO BOX 635
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91793-0635
Mailing Address - Country:US
Mailing Address - Phone:626-813-9988
Mailing Address - Fax:626-813-0049
Practice Address - Street 1:17310 WRIGHT ST STE 103
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2405
Practice Address - Country:US
Practice Address - Phone:833-228-6889
Practice Address - Fax:877-853-0376
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY14175C2085R0202X
ND179842085R0202X
CAA916272085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A916270Medicaid
CA00A916270OtherBCBS
CAP0041401OtherMEDICARE RR
CAWA91627BMedicare PIN
CAW11983Medicare PIN
CAI61559Medicare UPIN