Provider Demographics
NPI:1295055457
Name:LIN, MALINDA (MD)
Entity type:Individual
Prefix:DR
First Name:MALINDA
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 NEWPORT BLVD STE 235
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2281
Mailing Address - Country:US
Mailing Address - Phone:949-698-8215
Mailing Address - Fax:
Practice Address - Street 1:1901 NEWPORT BLVD STE 235
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2281
Practice Address - Country:US
Practice Address - Phone:949-698-8215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110122208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics