Healthcare Provider Details

I. General information

NPI: 1669553954
Provider Name (Legal Business Name): SHAO-POW LIN M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 WAGON TRAIL AVE
LAS VEGAS NV
89118-4426
US

IV. Provider business mailing address

1 INDEPENDENCE PT STE 202
GREENVILLE SC
29615-4536
US

V. Phone/Fax

Practice location:
  • Phone: 702-942-4123
  • Fax: 702-942-4124
Mailing address:
  • Phone: 877-406-2916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2002013710
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number13082
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: