Provider Demographics
NPI:1679676035
Name:LIN, GEORGE I (MD)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:I
Last Name:LIN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:18520 S AZUSA AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745
Mailing Address - Country:US
Mailing Address - Phone:626-964-2880
Mailing Address - Fax:626-964-2834
Practice Address - Street 1:1850 S AZUSA AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-6813
Practice Address - Country:US
Practice Address - Phone:626-964-2880
Practice Address - Fax:626-964-2834
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2010-11-18
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Provider Licenses
StateLicense IDTaxonomies
CAA67423207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A674230Medicaid
CA00A674230Medicaid
H41249Medicare UPIN