Healthcare Provider Details

I. General information

NPI: 1467831420
Provider Name (Legal Business Name): BONNIE LIN DPM A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2015
Last Update Date: 05/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 W LA VETA AVE SUITE 100
ORANGE CA
92868-4402
US

IV. Provider business mailing address

1439 W CHAPMAN AVE 250
ORANGE CA
92868-2738
US

V. Phone/Fax

Practice location:
  • Phone: 714-628-1995
  • Fax:
Mailing address:
  • Phone: 216-337-3636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: BONNIE LIN
Title or Position: PRESIDENT
Credential: DPM
Phone: 714-628-1995