Healthcare Provider Details

I. General information

NPI: 1962437434
Provider Name (Legal Business Name): JAY J LIN MD INC A PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22030 SHERMAN WAY SUITE 201
CANOGA PARK CA
91303-1855
US

IV. Provider business mailing address

22030 SHERMAN WAY STE 201
CANOGA PARK CA
91303-1885
US

V. Phone/Fax

Practice location:
  • Phone: 818-883-6840
  • Fax: 818-883-8828
Mailing address:
  • Phone: 818-883-6840
  • Fax: 818-883-8828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA31426
License Number StateCA

VIII. Authorized Official

Name: JAY JENSHONG LIN
Title or Position: OWNER
Credential: MD
Phone: 818-883-6840