Provider Demographics
NPI:1639154149
Name:HUANG, LIN (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:LIN
Middle Name:
Last Name:HUANG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 S UNION AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1322
Mailing Address - Country:US
Mailing Address - Phone:253-272-8148
Mailing Address - Fax:253-404-0506
Practice Address - Street 1:3209 S 23RD ST
Practice Address - Street 2:STE 340
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1602
Practice Address - Country:US
Practice Address - Phone:253-272-8148
Practice Address - Fax:253-404-0506
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000039882207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD00039882OtherWA LICENSE
WA8294092Medicaid
WAG8851596Medicare PIN
WAAB38990Medicare PIN
WAG8851597Medicare PIN
WAG8880511Medicare PIN
WAP00062469Medicare PIN
WA8851594Medicare PIN
WA001045700Medicare PIN
WAG8851594Medicare PIN
WAMD00039882OtherWA LICENSE
WAAB38989Medicare PIN
WA000188100Medicare PIN