Provider Demographics
NPI:1316265846
Name:LIN, AILEEN
Entity type:Individual
Prefix:MS
First Name:AILEEN
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 WELCH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1511
Mailing Address - Country:US
Mailing Address - Phone:650-721-2596
Mailing Address - Fax:650-724-5993
Practice Address - Street 1:750 WELCH RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1507
Practice Address - Country:US
Practice Address - Phone:650-721-2596
Practice Address - Fax:650-724-5993
Is Sole Proprietor?:No
Enumeration Date:2010-05-07
Last Update Date:2016-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA739328163W00000X
CA19575363LF0000X
CAFNP19575363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner