Provider Demographics
NPI:1316495013
Name:JEFFREY M LIN MD LLC
Entity type:Organization
Organization Name:JEFFREY M LIN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KOBASHIGAWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-523-5623
Mailing Address - Street 1:321 N KUAKINI ST STE 607
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2361
Mailing Address - Country:US
Mailing Address - Phone:808-824-0411
Mailing Address - Fax:808-523-5632
Practice Address - Street 1:321 N KUAKINI ST STE 607
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2361
Practice Address - Country:US
Practice Address - Phone:808-824-0411
Practice Address - Fax:808-523-5632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-11056207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIMD-11056OtherMEDICAL LICENSE