Healthcare Provider Details

I. General information

NPI: 1851524383
Provider Name (Legal Business Name): THAN S LIN D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E EMERSON AVE
MONTEREY PARK CA
91755
US

IV. Provider business mailing address

120 E EMERSON AVE
MONTEREY PARK CA
91755-1709
US

V. Phone/Fax

Practice location:
  • Phone: 626-280-0676
  • Fax:
Mailing address:
  • Phone: 626-280-0676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A10925
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number20A10925
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: