Healthcare Provider Details

I. General information

NPI: 1326542259
Provider Name (Legal Business Name): CHARLIE POISSON LIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20126 STANTON AVE STE 100
CASTRO VALLEY CA
94546-5270
US

IV. Provider business mailing address

20126 STANTON AVE STE 100
CASTRO VALLEY CA
94546-5270
US

V. Phone/Fax

Practice location:
  • Phone: 510-537-3556
  • Fax:
Mailing address:
  • Phone: 510-537-3556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA173959
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA173959
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberA173959
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: