Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 036115264 | IL |
NPI | 1447206677 |
---|---|
Provider Name | Dr. Johnny L. Lin |
First Address | Westchester, IL 60154-5701 |
Second Address | Chicago, IL 60612-4861 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 02/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036115264 1 | (05) | IL |
207067 | MEDICARE PTAN NUMBER LOCALITY #16 (01) | IL |
207073 | MEDICARE PTAN NUMBER LOCALITY #15 (01) | IL |
7686873 | AETNA (01) | IL |
DA4902 | RR MEDICARE PTAN NUMBER (01) | IL |
I34577 | (02) | IL |
P00381332 | RR MEDICARE PROVIDER NUMBER (01) | IL |