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General NPI Number Information
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NPI Number | 1659783546
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Entity Type | Individual
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Provider Name | EDWARD LIN D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/27/2014
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Last Update Date | 06/27/2022
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Provider Practice Location Address
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Address Line | 5111 SE LAKE RD
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City | MILWAUKIE
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State | OR
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Zip | 97222-4767
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Country | US
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Telephone | 503-771-0055
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Fax |
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Provider Business Mailing Address
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Address Line | 4502 SE PENNYWOOD DR
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City | MILWAUKIE
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State | OR
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Zip | 97222-3119
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Country | US
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Telephone | 352-871-7024
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO-183-869
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License Number State | OR
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