Provider Demographics
NPI:1982780367
Name:LIN, TAI-YUAN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:TAI-YUAN
Middle Name:DAVID
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:91-2135 FORT WEAVER RD
Mailing Address - Street 2:#300
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-1940
Mailing Address - Country:US
Mailing Address - Phone:808-677-6218
Mailing Address - Fax:808-677-4078
Practice Address - Street 1:91-2135 FORT WEAVER RD
Practice Address - Street 2:#300
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-1940
Practice Address - Country:US
Practice Address - Phone:808-677-6218
Practice Address - Fax:808-677-4078
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD13316207ZD0900X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI255380OtherHMSA
HI100531Medicare ID - Type Unspecified
HII35342Medicare UPIN