Provider Demographics
NPI:1386608065
Name:LIN, MIMI CHEN WUN (MD)
Entity type:Individual
Prefix:
First Name:MIMI
Middle Name:CHEN WUN
Last Name:LIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 REQUA RD
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4037
Mailing Address - Country:US
Mailing Address - Phone:510-644-6487
Mailing Address - Fax:
Practice Address - Street 1:39055 HASTINGS ST
Practice Address - Street 2:106A
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1518
Practice Address - Country:US
Practice Address - Phone:510-795-6990
Practice Address - Fax:510-795-6989
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist