1285795344 NPI number — CHING-CHUNG LIN

Table of content: (NPI 1285795344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285795344 NPI number — CHING-CHUNG LIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHING-CHUNG LIN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285795344
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10728 RAMONA BLVD
Provider Second Line Business Mailing Address:
STE F
Provider Business Mailing Address City Name:
EL MONTE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91731-2601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-448-9884
Provider Business Mailing Address Fax Number:
626-448-5032

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10728 RAMONA BLVD
Provider Second Line Business Practice Location Address:
STE F
Provider Business Practice Location Address City Name:
EL MONTE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91731-2601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-448-9884
Provider Business Practice Location Address Fax Number:
626-448-5032
Provider Enumeration Date:
12/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LIN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER AND PIC
Authorized Official Telephone Number:
626-448-9884

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHY45535 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PHA455350 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1997695 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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