Provider Demographics
NPI:1538374368
Name:LIN, STAN T (MD)
Entity type:Individual
Prefix:
First Name:STAN
Middle Name:T
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 SANTA RITA RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-4152
Mailing Address - Country:US
Mailing Address - Phone:925-484-4477
Mailing Address - Fax:
Practice Address - Street 1:2324 SANTA RITA RD
Practice Address - Street 2:SUITE 5
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-4152
Practice Address - Country:US
Practice Address - Phone:925-484-4477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA385622084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA28655Medicare UPIN
CA00A385620Medicare ID - Type Unspecified