1922190719 NPI number — DONG LIN MD PHD

Table of content: DONG LIN MD PHD (NPI 1922190719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922190719 NPI number — DONG LIN MD PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIN
Provider First Name:
DONG
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LIN
Provider Other First Name:
DONG
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD PHD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1922190719
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
950 STOCKTON STREET
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-399-9646
Provider Business Mailing Address Fax Number:
415-399-0156

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
950 STOCKTON STREET
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-399-9646
Provider Business Practice Location Address Fax Number:
415-399-0156
Provider Enumeration Date:
09/29/2006

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: 208000000X , with the licence number:  A66766 , 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: 9363733 . This is a "MEDI CAL PIN EDS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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