Provider Demographics
NPI:1245389881
Name:LIN, TED S (MD)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:S
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TAI
Other - Middle Name:SUN
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2190 LYNN RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1980
Mailing Address - Country:US
Mailing Address - Phone:805-496-9976
Mailing Address - Fax:805-496-9970
Practice Address - Street 1:2190 LYNN RD
Practice Address - Street 2:240
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1980
Practice Address - Country:US
Practice Address - Phone:805-496-9976
Practice Address - Fax:805-496-9970
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32918207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A32918Medicaid
CA00A32918Medicaid
CAA 26972Medicare UPIN