Healthcare Provider Details

I. General information

NPI: 1487650412
Provider Name (Legal Business Name): YUAN H LIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5565 GROSSMONT CENTER DR BUILDING 1 STE 221
LA MESA CA
91942-3022
US

IV. Provider business mailing address

350 K ST UNIT 303
SAN DIEGO CA
92101-6992
US

V. Phone/Fax

Practice location:
  • Phone: 619-421-1111
  • Fax: 619-421-1504
Mailing address:
  • Phone: 619-421-1111
  • Fax: 619-421-1504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA43050
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: