Healthcare Provider Details

I. General information

NPI: 1780812602
Provider Name (Legal Business Name): RUTH J LIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 S BASCOM AVE SUITE 310
SAN JOSE CA
95128-2604
US

IV. Provider business mailing address

751 S BASCOM AVE SUITE 310
SAN JOSE CA
95128
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-7973
  • Fax: 408-885-3079
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberA73229
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA73229
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: