Healthcare Provider Details

I. General information

NPI: 1114167178
Provider Name (Legal Business Name): GRACE Y LIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 04/11/2020
Certification Date: 04/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12462 PUTNAM ST STE 506
WHITTIER CA
90602-1049
US

IV. Provider business mailing address

12462 PUTNAM ST STE 506
WHITTIER CA
90602-1049
US

V. Phone/Fax

Practice location:
  • Phone: 626-988-1415
  • Fax: 562-698-9885
Mailing address:
  • Phone: 562-698-8141
  • Fax: 562-698-9885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA 106746
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA106746
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: