Healthcare Provider Details

I. General information

NPI: 1649289992
Provider Name (Legal Business Name): SAM YI-SHANG LIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79440 CORPORATE CENTER DR STE 110
LA QUINTA CA
92253-7243
US

IV. Provider business mailing address

81767 DR CARREON BLVD STE 201
INDIO CA
92201-5599
US

V. Phone/Fax

Practice location:
  • Phone: 760-391-5151
  • Fax: 760-775-4818
Mailing address:
  • Phone: 760-863-1562
  • Fax: 760-485-1561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA64634
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: