Provider Demographics
NPI:1649289992
Name:LIN, SAM YI-SHANG (MD)
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:YI-SHANG
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:81767 DR CARREON BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5599
Mailing Address - Country:US
Mailing Address - Phone:760-863-1562
Mailing Address - Fax:760-485-1561
Practice Address - Street 1:79440 CORPORATE CENTER DR STE 110
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-7243
Practice Address - Country:US
Practice Address - Phone:760-391-5151
Practice Address - Fax:760-775-4818
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2024-12-19
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Provider Licenses
StateLicense IDTaxonomies
CAA64634207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABQ537ZMedicare PIN