Healthcare Provider Details

I. General information

NPI: 1073531562
Provider Name (Legal Business Name): HSIU-SAN LIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 PARKVIEW PL SITEMAN CANCER CENTER LOWER LEVEL
SAINT LOUIS MO
63110-1032
US

IV. Provider business mailing address

660 S EUCLID AVE C B 8224
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-7236
  • Fax: 314-747-5735
Mailing address:
  • Phone: 314-747-7236
  • Fax: 314-747-5735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number34868
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: