Provider Demographics
NPI:1972558138
Name:LIN, JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
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 1:27055 ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1607
Mailing Address - Country:US
Mailing Address - Phone:310-623-0020
Mailing Address - Fax:661-670-0393
Practice Address - Street 1:27055 ISLAND RD
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1607
Practice Address - Country:US
Practice Address - Phone:310-623-0020
Practice Address - Fax:661-670-0393
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82618207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A826180OtherBLUE SHIELD
CAA82618OtherBLUE CROSS
CA00A826180Medicaid
CA00A826180OtherCALOPTIMA
CA00A826180OtherCALOPTIMA
CA00A826180Medicaid