Basic Information
| Provider Information | |||||||||
| NPI: | 1295912277 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIN | ||||||||
| FirstName: | ERINA | ||||||||
| MiddleName: | MAY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1131 WILSHIRE BLVD | ||||||||
| Address2: | SUITE # 202 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904012061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108250867 | ||||||||
| FaxNumber: | 4242598571 | ||||||||
| Practice Location | |||||||||
| Address1: | 1131 WILSHIRE BLVD | ||||||||
| Address2: | SUITE # 202 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108250867 | ||||||||
| FaxNumber: | 4242598571 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2008 | ||||||||
| LastUpdateDate: | 04/08/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | A77793 | CA | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology | 207KI0005X | A77793 | CA | N | Allopathic & Osteopathic Physicians | Allergy & Immunology | Clinical & Laboratory Immunology | 2080A0000X | A77793 | CA | N | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A77930 | 05 | CA | MEDICAID | A77793 | 01 | CA | MEDICAL LIC | OTHER |