Provider Demographics
NPI:1306908108
Name:LIN, LILY KOO (MD)
Entity type:Individual
Prefix:
First Name:LILY
Middle Name:KOO
Last Name:LIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LILY
Other - Middle Name:
Other - Last Name:KOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4860 Y ST
Mailing Address - Street 2:SUITE 2400
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2307
Mailing Address - Country:US
Mailing Address - Phone:916-734-6603
Mailing Address - Fax:916-734-6992
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:SUITE 2400
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-6603
Practice Address - Fax:916-734-6992
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90256207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI31586Medicare UPIN