Provider Demographics
NPI:1982784625
Name:LIN, PETER H (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:H
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 1:488 E SANTA CLARA ST STE 303
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-7231
Mailing Address - Country:US
Mailing Address - Phone:626-275-9566
Mailing Address - Fax:626-387-4188
Practice Address - Street 1:488 E SANTA CLARA ST STE 303
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-7231
Practice Address - Country:US
Practice Address - Phone:626-275-9566
Practice Address - Fax:626-387-4188
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL58102086S0129X
CAG1356872086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1982784625OtherMEDI-CAL
CACB234347Medicare UPIN
TXP00738097Medicare PIN
TX177365701Medicaid
8G1350Medicare PIN
TXP00669567Medicare PIN
TX177365702Medicaid