=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245260090
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WEN JUNG LIN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 515 SOUTH DR SUITE 14
-----------------------------------------------------
City | MOUNTAIN VIEW
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94040-4204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-966-1448
-----------------------------------------------------
Fax | 650-966-8107
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 515 SOUTH DR SUITE 14
-----------------------------------------------------
City | MOUNTAIN VIEW
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94040-4204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-966-1448
-----------------------------------------------------
Fax | 650-966-8107
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | A42424
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------