=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962437434
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAY J LIN MD INC A PROF CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2006
-----------------------------------------------------
Last Update Date | 09/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22030 SHERMAN WAY SUITE 201
-----------------------------------------------------
City | CANOGA PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91303-1855
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-883-6840
-----------------------------------------------------
Fax | 818-883-8828
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22030 SHERMAN WAY STE 201
-----------------------------------------------------
City | CANOGA PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91303-1885
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-883-6840
-----------------------------------------------------
Fax | 818-883-8828
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JAY JENSHONG LIN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 818-883-6840
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | A31426
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------