Provider Demographics
NPI:1538260922
Name:LIN, WENDY W (MD)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:W
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 1:9394 BIG HORN BLVD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-7977
Mailing Address - Country:US
Mailing Address - Phone:916-733-3333
Mailing Address - Fax:
Practice Address - Street 1:9394 BIG HORN BLVD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7977
Practice Address - Country:US
Practice Address - Phone:916-733-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63165207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000810343597OtherPHCS
CA1288631OtherGREAT WEST
CA4229216OtherCIGNA
CA00A631650OtherBLUE SHIELD
CA43651OtherINTERPLAN
CAA63165OtherBLUE CROSS
CA1845808OtherFIRST HEALTH
CA1896987OtherUNITED HEALTHCARE
CA00A631650Medicaid
CA078621OtherHEALTH NET
CA90103892OtherPACIFICARE
CA7737110OtherAETNA
CAMCMG128400OtherWESTERN HEALTH ADVANTAGE
CA1288631OtherGREAT WEST
CA7737110OtherAETNA