Basic Information
| Provider Information | |||||||||
| NPI: | 1235170820 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIN | ||||||||
| FirstName: | ALVIN | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5564 S. FORT APACHE ROAD #120 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026712355 | ||||||||
| FaxNumber: | 8885057769 | ||||||||
| Practice Location | |||||||||
| Address1: | 5564 S FORT APACHE RD STE 120 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891483601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028074181 | ||||||||
| FaxNumber: | 8885057769 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 09/19/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | 8206 | NV | Y | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100500484 | 05 | NV | MEDICAID | 100504439 | 01 | NV | MEDICAID NUMBER | OTHER | CS08928 | 01 | NV | PHARMACY LICENSE | OTHER | 8206 | 01 | NV | NEVADA LICENSE | OTHER | BL3426017 | 01 | NV | DEA LICENSE | OTHER |