Basic Information
Provider Information
NPI: 1265965867
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LIN
FirstName: BING-XUE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 960
Address2:  
City: BREMERTON
State: WA
PostalCode: 983370212
CountryCode: US
TelephoneNumber: 3478219360
FaxNumber:  
Practice Location
Address1: 320 S KITSAP BLVD
Address2:  
City: PORT ORCHARD
State: WA
PostalCode: 983663778
CountryCode: US
TelephoneNumber: 3603773776
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/10/2017
LastUpdateDate: 08/30/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/30/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207V00000X61163539WAY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansObstetrics & Gynecology 

ID Information
IDTypeStateIssuerDescription
13-397129801 13-3971298OTHER


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