MEDICARE: JENNIFER LIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	30777	AZ

General Provider Information

NPI Number	:	1124299847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER LIN M.D.

Provider Business Mailing Address
First Line	:	7320 N LA CHOLLA BLVD
Second Line	:	# 107
City	:	TUCSON
State	:	AZ
Zip	:	85741-2309
Country	:	US
Telephone Number	:	520-872-7265
Fax Number	:	520-872-7929

Provider Business Practice Location Address
First Line	:	7320 N LA CHOLLA BLVD
Second Line	:	# 107
City	:	TUCSON
State	:	AZ
Zip	:	85741-2309
Country	:	US
Telephone Number	:	520-872-7265
Fax Number	:	520-872-7929

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	SONIA URIBE
Credential	:
Telephone Number	:	520-872-7265

Provider Enumeration Date	:	03/20/2008
Last Update Date	:	03/20/2008

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