Provider Demographics
NPI:1487709531
Name:WILSON, LYNN EDWARD (MD)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:EDWARD
Last Name:WILSON
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 1:8135 PAINTER AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-3169
Mailing Address - Country:US
Mailing Address - Phone:562-698-0383
Mailing Address - Fax:562-693-6435
Practice Address - Street 1:8135 PAINTER AVE STE 300
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-3169
Practice Address - Country:US
Practice Address - Phone:562-698-0383
Practice Address - Fax:562-693-6435
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG17387207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0048970Medicaid
CAGR0048970Medicaid
CAA40069Medicare UPIN