Healthcare Provider Details

I. General information

NPI: 1457343568
Provider Name (Legal Business Name): STEVEN G LIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36949 COOK ST STE 101
PALM DESERT CA
92211-6080
US

IV. Provider business mailing address

36949 COOK ST STE 101
PALM DESERT CA
92211-6080
US

V. Phone/Fax

Practice location:
  • Phone: 760-340-2394
  • Fax: 760-340-2369
Mailing address:
  • Phone: 760-340-2394
  • Fax: 760-340-2369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG84610
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberG84610
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: