Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 94-01254 | NC |
NPI | 1194757633 |
---|---|
Provider Name | Dr. Jen-Jar Lin |
First Address | Winston Salem, NC 27102-0344 |
Second Address | Winston Salem, NC 27157-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 13/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1177E | BCBS (01) | NC |
1194757633 | (05) | VA |
202035 | MEDCOST (01) | NC |
3810009776 | (05) | WV |
5374708 | AETNA (01) | |
810643 | PARTNERS (01) | NC |
891177E | (05) | NC |
Q54094 | (05) | SC |