Provider Demographics
NPI:1457398760
Name:LIN, HENRY J (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:J
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 1:21840 NORMANDIE AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2047
Mailing Address - Country:US
Mailing Address - Phone:310-222-5133
Mailing Address - Fax:310-781-9352
Practice Address - Street 1:21840 NORMANDIE AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2047
Practice Address - Country:US
Practice Address - Phone:310-222-5133
Practice Address - Fax:310-781-9352
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47739207R00000X, 207SG0201X, 207SG0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Not Answered207SG0203XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Molecular Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G477390Medicaid
CAWG47739DMedicare ID - Type UnspecifiedPPIN
CAWG47739CMedicare ID - Type UnspecifiedPPIN
CA00G477390Medicaid
CAC88521Medicare UPIN