Provider Demographics
NPI:1124299847
Name:JENNIFER LIN M.D.
Entity type:Organization
Organization Name:JENNIFER LIN M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:URIBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-872-7265
Mailing Address - Street 1:7320 N LA CHOLLA BLVD
Mailing Address - Street 2:# 107
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2309
Mailing Address - Country:US
Mailing Address - Phone:520-872-7265
Mailing Address - Fax:520-872-7929
Practice Address - Street 1:7320 N LA CHOLLA BLVD
Practice Address - Street 2:# 107
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2309
Practice Address - Country:US
Practice Address - Phone:520-872-7265
Practice Address - Fax:520-872-7929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30777207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ106864Medicare PIN
AZH77540Medicare UPIN