Healthcare Provider Details

I. General information

NPI: 1720367972
Provider Name (Legal Business Name): ALLERGY & ASTHMA CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2011
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8008 MONET AVE SUITE 107
RANCHO CUCAMONGA CA
91739-7509
US

IV. Provider business mailing address

8008 MONET AVE SUITE 107
RANCHO CUCAMONGA CA
91739-7509
US

V. Phone/Fax

Practice location:
  • Phone: 909-463-6900
  • Fax: 909-463-1430
Mailing address:
  • Phone: 909-463-6900
  • Fax: 909-463-1430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberA70227
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberA70227
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberA70227
License Number StateCA

VIII. Authorized Official

Name: DR. HENRY LIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 909-463-6900