Provider Demographics
NPI:1992945570
Name:LIN, LAVINIA HSUAN-JU (MD)
Entity type:Individual
Prefix:
First Name:LAVINIA
Middle Name:HSUAN-JU
Last Name:LIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 650426
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0426
Mailing Address - Country:US
Mailing Address - Phone:972-233-1999
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:13601 PRESTON RD
Practice Address - Street 2:STE 1000W
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-4911
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122129207L00000X
TXN1736207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00584469OtherDRIVER LICENSE
TX8BZ065OtherBCBS
TX201602401Medicaid
TXN1736OtherSTATE LICENSE
TX8L10586Medicare PIN
TX8L11451Medicare PIN
TX8BZ065OtherBCBS
TX8L11452Medicare PIN