Provider Demographics
NPI:1114964202
Name:LIN, LAWRENCE L (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:L
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1000 NEWBURY RD STE 165
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91320-6439
Mailing Address - Country:US
Mailing Address - Phone:805-449-1778
Mailing Address - Fax:805-496-9970
Practice Address - Street 1:1000 NEWBURY RD STE 165
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91320-6439
Practice Address - Country:US
Practice Address - Phone:805-449-1778
Practice Address - Fax:805-496-9970
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2022-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA82619207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H57417Medicare UPIN
WA82619AMedicare PIN