Provider Demographics
NPI:1952328585
Name:LIN, JIMMY JING-CHYI (MD)
Entity Type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:JING-CHYI
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 1:2411 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1505
Mailing Address - Country:US
Mailing Address - Phone:408-983-1012
Mailing Address - Fax:408-983-1021
Practice Address - Street 1:2411 FOREST AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1505
Practice Address - Country:US
Practice Address - Phone:408-983-1012
Practice Address - Fax:408-983-1021
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38878207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A388780Medicare ID - Type Unspecified
CAA28748Medicare UPIN