Healthcare Provider Details

I. General information

NPI: 1114964202
Provider Name (Legal Business Name): LAWRENCE L LIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
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 TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberA82619
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: