Healthcare Provider Details

I. General information

NPI: 1740544980
Provider Name (Legal Business Name): KATRINA JESSICA LIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD 220
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

PO BOX 54679
LOS ANGELES CA
90054-0679
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-5252
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberA127014
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: