Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | G075685 | CA |
NPI | 1104880277 |
---|---|
Provider Name | Dr. Lucy L. Lin |
First Address | Los Gatos, CA 95032-0104 |
Second Address | Los Gatos, CA 95032-1440 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 01/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G12276 | (02) |