Healthcare Provider Details

I. General information

NPI: 1417214313
Provider Name (Legal Business Name): WONCHON LIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2012
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 TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA128895
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number17092
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License NumberA128895
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number17092
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: