Healthcare Provider Details

I. General information

NPI: 1033781232
Provider Name (Legal Business Name): SAN DIEGO CT SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7485 MISSION VALLEY RD STE 100
SAN DIEGO CA
92108-4422
US

IV. Provider business mailing address

11326 EUCALYPTUS HILLS DR
LAKESIDE CA
92040-1209
US

V. Phone/Fax

Practice location:
  • Phone: 619-823-3146
  • Fax: 619-554-8500
Mailing address:
  • Phone: 619-823-3146
  • Fax: 619-554-8500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. YUAN H LIN
Title or Position: MD
Credential: MD
Phone: 619-823-3146