1114996485 NPI number — DR. JENNIFER S LIN MD

Table of content: DR. JENNIFER S LIN MD (NPI 1114996485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114996485 NPI number — DR. JENNIFER S LIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIN
Provider First Name:
JENNIFER
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1114996485
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 NE 102ND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97220-3804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-813-2000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 NE 102ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97220-3804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-813-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/17/2006

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: 207R00000X , with the licence number:  MD00043344 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: MD26772 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00364819 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8393126 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8940783 . This is a "CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 005813 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0206291 . This is a "LABOR & IND." identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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