=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174778153
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SANTA CLARA FAMILY PRACTICE MEDICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2008
-----------------------------------------------------
Last Update Date | 11/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 499 S SUNNYVALE AVE
-----------------------------------------------------
City | SUNNYVALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94086-6123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-481-9800
-----------------------------------------------------
Fax | 408-481-9880
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 499 S SUNNYVALE AVE
-----------------------------------------------------
City | SUNNYVALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94086-6123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-481-9800
-----------------------------------------------------
Fax | 408-481-9880
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | YINGCHIH LIN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 408-481-9800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | G085438
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------