Provider Demographics
NPI:1942395983
Name:LIN, INIL LISA (MD)
Entity Type:Individual
Prefix:DR
First Name:INIL
Middle Name:LISA
Last Name:LIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6261 STANTON AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-2436
Mailing Address - Country:US
Mailing Address - Phone:714-739-4325
Mailing Address - Fax:714-452-1679
Practice Address - Street 1:6261 STANTON AVE
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-2436
Practice Address - Country:US
Practice Address - Phone:714-739-4325
Practice Address - Fax:714-452-1679
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2010-12-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA84233207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA84233AOtherPPIN
CAW11614OtherGROUP ID
CAWA84233AOtherPPIN