Healthcare Provider Details

I. General information

NPI: 1487935003
Provider Name (Legal Business Name): WEN I LIN M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 US HIGHWAY 1 S SUITE 2
SAINT AUGUSTINE FL
32086-6351
US

IV. Provider business mailing address

3100 US HIGHWAY 1 S SUITE 2
SAINT AUGUSTINE FL
32086-6351
US

V. Phone/Fax

Practice location:
  • Phone: 904-797-2921
  • Fax: 904-797-6715
Mailing address:
  • Phone: 904-797-2921
  • Fax: 904-797-6715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0032460
License Number StateFL

VIII. Authorized Official

Name: DR. WEN I LIN
Title or Position: OWNER/PHYSICAN
Credential: M.D.,P.A.
Phone: 904-797-2921