Healthcare Provider Details

I. General information

NPI: 1568213981
Provider Name (Legal Business Name): JIANNA LIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 CAMBRIDGE ST
BOSTON MA
02114-2783
US

IV. Provider business mailing address

133 PAGE RD
BEDFORD MA
01730-1821
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-4900
  • Fax:
Mailing address:
  • Phone: 781-835-7180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberPLLN103203
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: