Provider Demographics
NPI:1356446819
Name:LIN, DAVID W (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:7420 GREENHAVEN DR
Practice Address - Street 2:#130
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-5161
Practice Address - Country:US
Practice Address - Phone:916-399-6015
Practice Address - Fax:916-394-3344
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2015-07-22
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Provider Licenses
StateLicense IDTaxonomies
CAA54643207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A546430Medicaid
00A546431Medicare ID - Type Unspecified
CA00A546430Medicaid