Basic Information
| Provider Information | |||||||||
| NPI: | 1053706309 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIN | ||||||||
| FirstName: | AARON | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1514 VALLEY VISTA DR | ||||||||
| Address2: | |||||||||
| City: | DIAMOND BAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917653929 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1514 VALLEY VISTA DR | ||||||||
| Address2: | ST JUDE HERITAGE MEDICAL GROUP | ||||||||
| City: | DIAMOND BAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098601144 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2015 | ||||||||
| LastUpdateDate: | 11/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 125066917 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 036.146095 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 20A16396 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.