Provider Demographics
NPI:1255871711
Name:LIN, ETHAN WIN THEIN (MD)
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:WIN THEIN
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 WILSHIRE BLVD APT 2507
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-1963
Mailing Address - Country:US
Mailing Address - Phone:510-612-5529
Mailing Address - Fax:
Practice Address - Street 1:1100 WILSHIRE BLVD APT 2507
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-1963
Practice Address - Country:US
Practice Address - Phone:510-612-5529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-03
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.47106207Q00000X
DEC1-0025351208M00000X
390200000X
CAA164328208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program