Individual provider Active NPI

Corey Lin, PT, DPT

  • Orthopedic Physical Therapist
  • Los Angeles, CA
National Provider Identifier
1497399109
Registry record updated Nov 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
297526 Issued in CA
Practice address
11611 San Vicente Blvd
Los Angeles, CA 90049-5106
Phone
(562) 833-3508
NPI assigned
Nov 5, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 5, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X 297526 CA Primary

Addresses

Primary practice location

11611 San Vicente Blvd
Los Angeles, CA 90049-5106

Mailing address

13163 Fountain Park Dr Apt B218
Los Angeles, CA 90094-2418
Phone (562) 833-3508

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191217003056 CA Practitioner - Physical Therapist in Private Practice 4880028281 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
297526CAMDOrthopedic Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Brentview Medical Inc. CurrentSince Nov 12, 2019 Accepting new patients
Brentview Medical Inc. CurrentSince Nov 12, 2019 Accepting new patients
California Luna Care Physical Therapy PC Orthopedic CurrentSince May 1, 2020 Accepting new patients
Skinpeccable Inc. Current Accepting new patients
BVM Therapy Inc. Past Accepting new patients

Locations

11611 San Vicente Blvd
Los Angeles, CA 90049
Phone (310) 447-6060

11611 San Vicente Blvd
Ste GF1
Los Angeles, CA 90049
Phone (310) 820-0013

16185 Los Gatos Blvd
Ste 205
Los Gatos, CA 95032
Phone (408) 459-8108

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1572912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572912000000",
    "number": "1497399109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13163 FOUNTAIN PARK DR APT B218",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900942418",
            "telephone_number": "562-833-3508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11611 SAN VICENTE BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900495106",
            "telephone_number": "562-833-3508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIN",
        "first_name": "COREY",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-11-05",
        "last_updated": "2019-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CA",
            "license": "297526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.