1023161379 NPI number — TERRY C. LIN D.O.,INC.

Table of content: (NPI 1023161379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023161379 NPI number — TERRY C. LIN D.O.,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TERRY C. LIN D.O.,INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023161379
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2520 SAMARITAN DR STE 201B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95124-4106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-358-6580
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2520 SAMARITAN DR.
Provider Second Line Business Practice Location Address:
#201
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-582-0814
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/19/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LIN
Authorized Official First Name:
TERRY
Authorized Official Middle Name:
C
Authorized Official Title or Position:
GASTROENTERLOGY
Authorized Official Telephone Number:
888-582-0814

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  A65180 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00107274 . This is a "MEDICARE ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".