1164683876 NPI number — DR. ELINOR YEN-RU LIN M.D.

Table of content: DR. ELINOR YEN-RU LIN M.D. (NPI 1164683876)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164683876 NPI number — DR. ELINOR YEN-RU LIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIN
Provider First Name:
ELINOR
Provider Middle Name:
YEN-RU
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1164683876
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1045 ATLANTIC AVE
Provider Second Line Business Mailing Address:
SUITE 719
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90813-3408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-437-1054
Provider Business Mailing Address Fax Number:
562-424-9990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1045 ATLANTIC AVE
Provider Second Line Business Practice Location Address:
SUITE 719
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90813-3408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-437-1054
Provider Business Practice Location Address Fax Number:
562-424-9990
Provider Enumeration Date:
06/24/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: MT193007 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: A110043 , 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)