MEDICARE: WONCHON 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	207W00000X	Ophthalmology Physician	A128895	CA
2	207WX0120X	Cornea and External Diseases Specialist Physician	17092	NV
3	207WX0120X	Cornea and External Diseases Specialist Physician	A128895	CA
4	207W00000X	Ophthalmology Physician	17092	NV

General Provider Information

NPI Number	:	1417214313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WONCHON LIN M.D.

Provider Business Mailing Address
First Line	:	4974 S RAINBOW BLVD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1413
Country	:	US
Telephone Number	:	702-570-2820
Fax Number	:	831-604-0306

Provider Business Practice Location Address
First Line	:	4974 S RAINBOW BLVD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1413
Country	:	US
Telephone Number	:	702-570-2820
Fax Number	:	831-604-0306

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2012
Last Update Date	:	07/06/2025

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