Provider Demographics
NPI:1427072453
Name:LIN, NOBEL (PA)
Entity type:Individual
Prefix:MR
First Name:NOBEL
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 W REDONDO BEACH BLVD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-3586
Mailing Address - Country:US
Mailing Address - Phone:310-329-8631
Mailing Address - Fax:310-329-8625
Practice Address - Street 1:1141 W REDONDO BEACH BLVD
Practice Address - Street 2:SUITE 402
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3586
Practice Address - Country:US
Practice Address - Phone:310-329-8631
Practice Address - Fax:310-329-8636
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17716174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPA17716BOtherMEDICARE PPIN GOLDEN EAR
WPA17716AOtherMEDICARE, GARY FORD, INC.
Q46342OtherMEDICARE UPIN
WPA17716AOtherMEDICARE, GARY FORD, INC.
CAWPA17716BOtherMEDICARE PPIN GOLDEN EAR