Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | A70227 | CA |
N | 207RA0201X | Internist - Allergy & Immunology | A70227 | CA |
NPI | 1407966500 |
---|---|
Provider Name | Henry Lin |
First Address | Rancho Cucamonga, CA 91739-8890 |
Second Address | Rancho Cucamonga, CA 91739-7509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 11/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H96167 | (02) |