Provider Demographics
NPI:1114963873
Name:LIN, SHOU I (MD)
Entity Type:Individual
Prefix:DR
First Name:SHOU I
Middle Name:
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 1:75 W MARCH LANE
Mailing Address - Street 2:#G
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5729
Mailing Address - Country:US
Mailing Address - Phone:209-951-6072
Mailing Address - Fax:209-951-0181
Practice Address - Street 1:75 W MARCH LANE
Practice Address - Street 2:#G
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5729
Practice Address - Country:US
Practice Address - Phone:209-951-6072
Practice Address - Fax:209-951-0181
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33667208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics