Provider Demographics
NPI:1922190719
Name:LIN, DONG (MD PHD)
Entity Type:Individual
Prefix:
First Name:DONG
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:DONG
Other - Middle Name:
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD PHD
Mailing Address - Street 1:950 STOCKTON STREET
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108
Mailing Address - Country:US
Mailing Address - Phone:415-399-9646
Mailing Address - Fax:415-399-0156
Practice Address - Street 1:950 STOCKTON STREET
Practice Address - Street 2:SUITE 207
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108
Practice Address - Country:US
Practice Address - Phone:415-399-9646
Practice Address - Fax:415-399-0156
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66766208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9363733OtherMEDI CAL PIN EDS
CA9363733OtherMEDI CAL PIN EDS
H17515Medicare UPIN