Healthcare Provider Details

I. General information

NPI: 1952784019
Provider Name (Legal Business Name): VIVIAN LIN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

8549 WILSHIRE BLVD #1232
BEVERLY HILLS CA
90211-3104
US

V. Phone/Fax

Practice location:
  • Phone: 909-896-8582
  • Fax:
Mailing address:
  • Phone: 424-256-6906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA127990
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA127990
License Number StateCA

VIII. Authorized Official

Name: VIVIAN LIN
Title or Position: OWNER / PRESIDENT
Credential: MD
Phone: 424-256-6906