Healthcare Provider Details

I. General information

NPI: 1538841101
Provider Name (Legal Business Name): LIN HEALTH MEDICAL GROUP OF CALIFORNIA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 ALMADEN BLVD STE 600
SAN JOSE CA
95113-1605
US

IV. Provider business mailing address

3513 BRIGHTON BLVD STE 457
DENVER CO
80216-3810
US

V. Phone/Fax

Practice location:
  • Phone: 669-201-5014
  • Fax:
Mailing address:
  • Phone: 720-740-2520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JESSIE DALTON
Title or Position: DIRECTOR, REVENUE & OPERATIONS
Credential:
Phone: 720-782-1046