Healthcare Provider Details

I. General information

NPI: 1942683487
Provider Name (Legal Business Name): SHINTAU LIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2015
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 LOMITA BLVD STE 100
HARBOR CITY CA
90710-2084
US

IV. Provider business mailing address

1403 LOMITA BLVD STE 100
HARBOR CITY CA
90710-2084
US

V. Phone/Fax

Practice location:
  • Phone: 310-534-7600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA145461
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA145461
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: