Provider Demographics
NPI:1942399050
Name:LANG, LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:
Last Name:LANG
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 1:1558 POOLE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-2607
Mailing Address - Country:US
Mailing Address - Phone:530-755-0882
Mailing Address - Fax:530-755-0885
Practice Address - Street 1:1558 POOLE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-2607
Practice Address - Country:US
Practice Address - Phone:530-755-0882
Practice Address - Fax:530-755-0885
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68738207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A687380Medicaid
CAH19241Medicare UPIN
CA00A687380Medicaid