Healthcare Provider Details

I. General information

NPI: 1902443542
Provider Name (Legal Business Name): WONCHON LIN, M.D., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2019
Last Update Date: 07/06/2025
Certification Date: 07/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4974 S RAINBOW BLVD STE 100
LAS VEGAS NV
89118-1413
US

IV. Provider business mailing address

4974 S RAINBOW BLVD STE 100
LAS VEGAS NV
89118-1413
US

V. Phone/Fax

Practice location:
  • Phone: 702-570-2820
  • Fax: 831-604-0306
Mailing address:
  • Phone: 702-570-2820
  • Fax: 831-604-0306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number
License Number State

VIII. Authorized Official

Name: WONCHON LIN
Title or Position: MANAGER
Credential: MD
Phone: 702-570-2820