Provider Demographics
NPI:1801109673
Name:JONATHAN C LIN M D MEDICAL CORPORATION
Entity type:Organization
Organization Name:JONATHAN C LIN M D MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-321-2500
Mailing Address - Street 1:35900 BOB HOPE DR
Mailing Address - Street 2:SUITE 275
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-1766
Mailing Address - Country:US
Mailing Address - Phone:760-321-2500
Mailing Address - Fax:760-321-5720
Practice Address - Street 1:35900 BOB HOPE DR
Practice Address - Street 2:SUITE 275
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-1766
Practice Address - Country:US
Practice Address - Phone:760-321-2500
Practice Address - Fax:760-321-5720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92677207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI62019Medicare UPIN