Provider Demographics
NPI:1649483033
Name:LIN, HENRY CHIUNG-HENG (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:CHIUNG-HENG
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 1:12223 HIGHLAND AVE.
Mailing Address - Street 2:SUITE 106 P.O BOX 588
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739
Mailing Address - Country:US
Mailing Address - Phone:760-268-2063
Mailing Address - Fax:760-513-9013
Practice Address - Street 1:15366 11TH ST STE D
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3726
Practice Address - Country:US
Practice Address - Phone:760-268-2063
Practice Address - Fax:760-513-9013
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107466207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology