Provider Demographics
NPI:1891704169
Name:LIN, JEFFREY HENG-YI (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:HENG-YI
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 1:190 E BANNOCK ST
Mailing Address - Street 2:JEFFERY LIN MD
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712
Mailing Address - Country:US
Mailing Address - Phone:208-381-8866
Mailing Address - Fax:208-381-8786
Practice Address - Street 1:190 E. BANNOCK ST.
Practice Address - Street 2:JEFFERY LIN MD
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712
Practice Address - Country:US
Practice Address - Phone:208-381-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD0044230207RC0200X, 207RS0012X
IDM-8865207RP1001X
WAMD00044230207RP1001X
IDM-13383207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA103302OtherMEDICAL BOARD OF CALIFORNIA
IDM-8865OtherMD STATE LICENSE
WAMD00044230OtherMD STATE LICENSE
ID807724500Medicaid
ID807724500Medicaid