Healthcare Provider Details

I. General information

NPI: 1679553101
Provider Name (Legal Business Name): JENNIFER LIN KHOE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER I. LIN M.D.

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 VANDEVER AVE
SAN DIEGO CA
92120-3315
US

IV. Provider business mailing address

FILE# 54433
LOS ANGELES CA
90074-0001
US

V. Phone/Fax

Practice location:
  • Phone: 619-662-1222
  • Fax: 619-516-7508
Mailing address:
  • Phone: 858-784-5906
  • Fax: 858-784-5922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA91543
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: