Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G85904 | CA |
N | 207ND0101X | MOHS-Micrographic Surgeon | 38236 | MN |
N | 207ND0101X | MOHS-Micrographic Surgeon | G85904 | CA |
N | 207NS0135X | Procedural Dermatology | 38236 | MN |
N | 207NS0135X | Procedural Dermatology | G85904 | CA |
NPI | 1043373889 |
---|---|
Provider Name | Bertha Bin-San Lin |
First Address | Santa Rosa, CA 95403-2805 |
Second Address | Santa Rosa, CA 95405-7898 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 01/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G19012 | (02) | |
G85904 | LICENSE NUMBER (01) | CA |