Healthcare Provider Details

I. General information

NPI: 1508070046
Provider Name (Legal Business Name): CHRISTINE LIN JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE LIN MD

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N PROVIDENCE DR STE 310
NEWBERG OR
97132-7582
US

IV. Provider business mailing address

PO BOX 3158
PORTLAND OR
97208-3158
US

V. Phone/Fax

Practice location:
  • Phone: 503-537-6040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD157639
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD157639
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD157639
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: