Healthcare Provider Details

I. General information

NPI: 1952314601
Provider Name (Legal Business Name): ALEXANDER S. LIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3731 S PLAZA DR
SANTA ANA CA
92704-7463
US

IV. Provider business mailing address

PO BOX 3917
COSTA MESA CA
92628-3917
US

V. Phone/Fax

Practice location:
  • Phone: 714-547-3346
  • Fax: 714-547-3252
Mailing address:
  • Phone: 714-547-3346
  • Fax: 714-547-3252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG38003
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: