Provider Demographics
NPI:1255515987
Name:EVERGREEN GOLDEN HEALTH CENTER A MEDICAL CORPORATION
Entity type:Organization
Organization Name:EVERGREEN GOLDEN HEALTH CENTER A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:408-243-1528
Mailing Address - Street 1:888 N WINCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1353
Mailing Address - Country:US
Mailing Address - Phone:408-243-1528
Mailing Address - Fax:408-243-7366
Practice Address - Street 1:888 N WINCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1353
Practice Address - Country:US
Practice Address - Phone:408-243-1528
Practice Address - Fax:408-243-7366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP36749261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA29704Medicare UPIN