Provider Demographics
NPI:1063608891
Name:LIN, JUSTIN CHIEN-YO (DPT)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:CHIEN-YO
Last Name:LIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14661 MYFORD RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7205
Mailing Address - Country:US
Mailing Address - Phone:714-900-3880
Mailing Address - Fax:714-731-0932
Practice Address - Street 1:14661 MYFORD RD
Practice Address - Street 2:SUITE C
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7205
Practice Address - Country:US
Practice Address - Phone:714-900-3880
Practice Address - Fax:714-731-0932
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052051062251X0800X
CA35795225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA542045764OtherBC/BS
CA136850ZA16Medicare PIN