Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 35795 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | 2305205106 | VA |
NPI | 1063608891 |
---|---|
Provider Name | Dr. Justin Chien-Yo Lin |
First Address | Tustin, CA 92780-7205 |
Second Address | Tustin, CA 92780-7205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2007 |
Last Update Date | 07/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
542045764 | BC/BS (01) | VA |