Basic Information
| Provider Information | |||||||||
| NPI: | 1194928002 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIN | ||||||||
| FirstName: | TOM | ||||||||
| MiddleName: | YIH-CHAO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11311 BRIDGEPORT WAY SW | ||||||||
| Address2: | STE 311 | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984993071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535893677 | ||||||||
| FaxNumber: | 2535898477 | ||||||||
| Practice Location | |||||||||
| Address1: | 3660 PARK SIERRA DR | ||||||||
| Address2: | STE 105 | ||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925053071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512788870 | ||||||||
| FaxNumber: | 9512788913 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2007 | ||||||||
| LastUpdateDate: | 04/17/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD00047583 | WA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 8484677 | 05 | WA | MEDICAID | 0221364 | 01 | WA | STATE L&I | OTHER | 8945104 | 01 | WA | STATE CRIME VICTIMS | OTHER |