Provider Demographics
NPI:1326146937
Name:LIN, VICKI Y (MD)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:Y
Last Name:LIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18693 BROOKHURST ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6749
Mailing Address - Country:US
Mailing Address - Phone:714-465-9978
Mailing Address - Fax:714-465-9986
Practice Address - Street 1:18693 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6749
Practice Address - Country:US
Practice Address - Phone:714-465-9978
Practice Address - Fax:714-465-9986
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93290207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADE237ZMedicare UPIN
CADE237YMedicare UPIN