1063608891 NPI number — DR. JUSTIN CHIEN-YO LIN DPT

Table of content: DR. JUSTIN CHIEN-YO LIN DPT (NPI 1063608891)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063608891 NPI number — DR. JUSTIN CHIEN-YO LIN DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIN
Provider First Name:
JUSTIN
Provider Middle Name:
CHIEN-YO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
M

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:
1063608891
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14661 MYFORD RD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
TUSTIN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92780-7205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-900-3880
Provider Business Mailing Address Fax Number:
714-731-0932

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14661 MYFORD RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
TUSTIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92780-7205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-900-3880
Provider Business Practice Location Address Fax Number:
714-731-0932
Provider Enumeration Date:
09/14/2007

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: 2251X0800X , with the licence number:  2305205106 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 35795 , 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: 542045764 . This is a "BC/BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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