Provider Demographics
NPI:1104880277
Name:LIN, LUCY L (MD)
Entity type:Individual
Prefix:DR
First Name:LUCY
Middle Name:L
Last Name:LIN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 320282
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-0104
Mailing Address - Country:US
Mailing Address - Phone:408-374-7511
Mailing Address - Fax:408-374-9083
Practice Address - Street 1:320 DARDANELLI LN
Practice Address - Street 2:STE 17
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1440
Practice Address - Country:US
Practice Address - Phone:408-374-7511
Practice Address - Fax:408-374-9083
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG075685204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G756850Medicare PIN
G12276Medicare UPIN