Healthcare Provider Details

I. General information

NPI: 1073553590
Provider Name (Legal Business Name): LAWRENCE L LIN MD PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 05/08/2022
Certification Date: 05/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 NEWBURY RD STE 165
THOUSAND OAKS CA
91320-6439
US

IV. Provider business mailing address

1000 NEWBURY RD STE 165
THOUSAND OAKS CA
91320-6439
US

V. Phone/Fax

Practice location:
  • Phone: 805-449-1778
  • Fax: 805-496-9970
Mailing address:
  • Phone: 805-449-1778
  • Fax: 805-496-9970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: LAWRENCE L LIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 805-449-1778