Healthcare Provider Details

I. General information

NPI: 1417975392
Provider Name (Legal Business Name): ROSE HWEI-DA LIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1831 WILSHIRE BLVD STE A
SANTA MONICA CA
90403-5778
US

IV. Provider business mailing address

4077 5TH AVE MER 35, DEPARTMENT OF MEDICAL EDUCATION
SAN DIEGO CA
92103-2105
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-8584
  • Fax: 424-291-4205
Mailing address:
  • Phone: 619-626-3802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA90043
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA90043
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: