Basic Information
| Provider Information | |||||||||
| NPI: | 1083619100 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIN | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | SC | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 223 N 1ST AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | ARCADIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910067027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6266987246 | ||||||||
| FaxNumber: | 6264471058 | ||||||||
| Practice Location | |||||||||
| Address1: | 960 E GREEN ST STE L-60 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911062423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267933339 | ||||||||
| FaxNumber: | 6267933118 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2005 | ||||||||
| LastUpdateDate: | 05/26/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | A51128 | CA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VX0201X | A51128 | CA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
ID Information
| ID | Type | State | Issuer | Description | 00A51125D | 05 | CA | MEDICAID |