Provider Demographics
NPI:1447371224
Name:LIN, MICHAEL
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2081 ARENA BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-2309
Mailing Address - Country:US
Mailing Address - Phone:916-285-8971
Mailing Address - Fax:916-285-0338
Practice Address - Street 1:1000 RIVER ROCK DR
Practice Address - Street 2:SUITE 210
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-2093
Practice Address - Country:US
Practice Address - Phone:916-990-9159
Practice Address - Fax:916-990-9362
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA843292084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACH184ZMedicare PIN