Provider Demographics
NPI:1124169636
Name:LIN, KEN C (MD)
Entity type:Individual
Prefix:DR
First Name:KEN
Middle Name:C
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1441 KAPIOLANI BLVD STE 1488
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4471
Mailing Address - Country:US
Mailing Address - Phone:808-946-7889
Mailing Address - Fax:808-946-7880
Practice Address - Street 1:1441 KAPIOLANI BLVD STE 1488
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4471
Practice Address - Country:US
Practice Address - Phone:808-946-7889
Practice Address - Fax:808-946-7880
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD10751207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI25229501Medicaid
HI00B0216883OtherHMSA PIN
HIMD 10751OtherMEDICAL LICENSE
HIG74499Medicare UPIN
HIMD 10751OtherMEDICAL LICENSE