Provider Demographics
NPI:1437898533
Name:LIN, INGRID (MD)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3145 PORTER DR.
Mailing Address - Street 2:WING B, MC 5395
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1234
Mailing Address - Country:US
Mailing Address - Phone:650-725-8995
Mailing Address - Fax:
Practice Address - Street 1:3145 PORTER DR.
Practice Address - Street 2:WING B, MC 5395
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1234
Practice Address - Country:US
Practice Address - Phone:650-725-8995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA635392080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics