MEDICARE: DR. ROSE HWEI-DA 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	A90043	CA
2	207R00000X	Internal Medicine Physician	A90043	CA

General Provider Information

NPI Number	:	1417975392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSE HWEI-DA LIN M.D.

Provider Business Mailing Address
First Line	:	4077 5TH AVE
Second Line	:	MER 35, DEPARTMENT OF MEDICAL EDUCATION
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2105
Country	:	US
Telephone Number	:	619-626-3802
Fax Number	:

Provider Business Practice Location Address
First Line	:	1831 WILSHIRE BLVD STE A
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5778
Country	:	US
Telephone Number	:	310-829-8584
Fax Number	:	424-291-4205

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	04/16/2021

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