Healthcare Provider Details

I. General information

NPI: 1205130036
Provider Name (Legal Business Name): SHINKO LIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5893 COPLEY DR
SAN DIEGO CA
92111-7906
US

IV. Provider business mailing address

5893 COPLEY DR
SAN DIEGO CA
92111-7906
US

V. Phone/Fax

Practice location:
  • Phone: 858-212-5626
  • Fax: 858-616-5065
Mailing address:
  • Phone: 858-212-5626
  • Fax: 858-616-5065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA120354
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberA120354
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: