Healthcare Provider Details

I. General information

NPI: 1063608891
Provider Name (Legal Business Name): JUSTIN CHIEN-YO LIN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 12/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14661 MYFORD RD SUITE C
TUSTIN CA
92780-7205
US

IV. Provider business mailing address

14661 MYFORD RD SUITE C
TUSTIN CA
92780-7205
US

V. Phone/Fax

Practice location:
  • Phone: 714-900-3880
  • Fax: 714-731-0932
Mailing address:
  • Phone: 714-900-3880
  • Fax: 714-731-0932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number35795
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2305205106
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: