=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912101619
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEX SYNBOND LIN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2007
-----------------------------------------------------
Last Update Date | 11/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1800 FAIRBURN AVE STE 211
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90025-4968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-277-9414
-----------------------------------------------------
Fax | 818-461-8961
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1800 FAIRBURN AVE STE 211
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90025-4968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-277-9414
-----------------------------------------------------
Fax | 818-461-8961
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | A93176
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------