Provider Demographics
NPI:1881125490
Name:LIN, WILLIAM
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42325 BLACOW RD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-5568
Mailing Address - Country:US
Mailing Address - Phone:510-585-8111
Mailing Address - Fax:
Practice Address - Street 1:4400 CENTRAL AVE
Practice Address - Street 2:APT 205
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-5872
Practice Address - Country:US
Practice Address - Phone:510-585-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71932183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist