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General NPI Number Information
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NPI Number | 1841065992
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Entity Type | Individual
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Provider Name | JASON LIN
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Gender | Male
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Dates
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Enumeration Date | 11/20/2023
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Last Update Date | 02/15/2024
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Provider Practice Location Address
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Address Line | 1973 FOOTHILL PKWY UNIT 104
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City | CORONA
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State | CA
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Zip | 92881-4110
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Country | US
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Telephone | 951-460-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 2038 S BON VIEW AVE UNIT F
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City | ONTARIO
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State | CA
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Zip | 91761-5511
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Country | US
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Telephone |
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 95027139
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License Number State | CA
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