Provider Demographics
NPI:1548313760
Name:LIN, BERWYN JC (MD)
Entity type:Individual
Prefix:
First Name:BERWYN
Middle Name:JC
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:600 N GARFIELD AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1169
Mailing Address - Country:US
Mailing Address - Phone:626-288-1468
Mailing Address - Fax:626-288-3376
Practice Address - Street 1:600 N GARFIELD AVE STE 203
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1169
Practice Address - Country:US
Practice Address - Phone:626-288-1468
Practice Address - Fax:626-288-3376
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA40981208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A409810Medicaid