Provider Demographics
NPI:1902034887
Name:LIN, BONNIE (DPM)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:1439 W CHAPMAN AVE
Mailing Address - Street 2:STE 250
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2738
Mailing Address - Country:US
Mailing Address - Phone:805-482-0711
Mailing Address - Fax:805-482-6524
Practice Address - Street 1:705 W LA VETA AVE
Practice Address - Street 2:STE 100
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4447
Practice Address - Country:US
Practice Address - Phone:714-628-1995
Practice Address - Fax:714-628-1983
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2360213ES0103X
CAE4879213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery