Provider Demographics
NPI:1023252855
Name:LIN, SALLY (MD)
Entity type:Individual
Prefix:DR
First Name:SALLY
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3553 WHIPPLE ROAD
Mailing Address - Street 2:BLDG B, 1ST FLOOR, DEPT OF OPHTHALMOLOGY
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587
Mailing Address - Country:US
Mailing Address - Phone:510-675-2020
Mailing Address - Fax:510-675-4782
Practice Address - Street 1:3553 WHIPPLE ROAD
Practice Address - Street 2:BLDG B, 1ST FLOOR
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587
Practice Address - Country:US
Practice Address - Phone:510-675-2020
Practice Address - Fax:510-675-4782
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA113467207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program