Healthcare Provider Details

I. General information

NPI: 1740385889
Provider Name (Legal Business Name): VERNON WENHAU LIN MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 08/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E 7TH ST
LONG BEACH CA
90822-5201
US

IV. Provider business mailing address

2500 N STATE ST
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 562-826-5049
  • Fax: 562-826-5631
Mailing address:
  • Phone: 601-984-5706
  • Fax: 601-984-5733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License NumberG75880
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number25007
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: