Healthcare Provider Details

I. General information

NPI: 1982780367
Provider Name (Legal Business Name): TAI-YUAN DAVID LIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-2135 FORT WEAVER RD #300
EWA BEACH HI
96706-1940
US

IV. Provider business mailing address

91-2135 FORT WEAVER RD #300
EWA BEACH HI
96706-1940
US

V. Phone/Fax

Practice location:
  • Phone: 808-677-6218
  • Fax: 808-677-4078
Mailing address:
  • Phone: 808-677-6218
  • Fax: 808-677-4078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberMD13316
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD13316
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: