Provider Demographics
NPI:1023003670
Name:LIN, VIKI T
Entity Type:Individual
Prefix:
First Name:VIKI
Middle Name:T
Last Name:LIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 PLAZA DEL AMO
Mailing Address - Street 2:#171
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-9372
Mailing Address - Country:US
Mailing Address - Phone:310-701-2956
Mailing Address - Fax:310-363-1970
Practice Address - Street 1:2420 VELA WAY
Practice Address - Street 2:SUITE 1467
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245
Practice Address - Country:US
Practice Address - Phone:310-363-3981
Practice Address - Fax:310-363-1970
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75924207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine