Provider Demographics
NPI:1962437434
Name:JAY J. LIN M.D. INC
Entity type:Organization
Organization Name:JAY J. LIN M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-883-6840
Mailing Address - Street 1:22030 SHERMAN WAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-1855
Mailing Address - Country:US
Mailing Address - Phone:818-883-6840
Mailing Address - Fax:818-883-8828
Practice Address - Street 1:22030 SHERMAN WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1855
Practice Address - Country:US
Practice Address - Phone:818-883-6840
Practice Address - Fax:818-883-8828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
CAA31426261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A314260Medicaid
CAW21632OtherMEDICARE GROUP
CA00A314260Medicaid
CAWA31426AMedicare PIN