=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336589688
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMES J.D. LIN, M.D A MEDICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2013
-----------------------------------------------------
Last Update Date | 07/01/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 340 W CENTRAL AVE STE 122
-----------------------------------------------------
City | BREA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92821-3006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-529-8923
-----------------------------------------------------
Fax | 714-529-7017
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 340 W CENTRAL AVE STE 122
-----------------------------------------------------
City | BREA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92821-3006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-529-8923
-----------------------------------------------------
Fax | 714-529-7017
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JAMES J.D LIN
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 714-529-8923
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | A-030146
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------