Provider Demographics
NPI:1912014481
Name:LIN, JULIE CHOW (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:CHOW
Last Name:LIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1294 W 6TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-2987
Mailing Address - Country:US
Mailing Address - Phone:310-548-9118
Mailing Address - Fax:310-548-1310
Practice Address - Street 1:1294 W 6TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-2987
Practice Address - Country:US
Practice Address - Phone:310-548-9118
Practice Address - Fax:310-548-1310
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA78926208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A789230Medicaid
CA00A789230Medicaid