1588262869 NPI number — SAMUEL LIN, ND, PLLC

Table of content: (NPI 1780650531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588262869 NPI number — SAMUEL LIN, ND, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAMUEL LIN, ND, PLLC
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:
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:
1588262869
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9805 NE 116TH ST PMB #A328
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KIRKLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-363-9399
Provider Business Mailing Address Fax Number:
425-363-9388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13410 HWY 99
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-363-9399
Provider Business Practice Location Address Fax Number:
425-363-9388
Provider Enumeration Date:
10/09/2020

Additional Information

Authorized Official

Authorized Official Last Name:
POSTON
Authorized Official First Name:
J. ELISE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
425-444-8844

Provider Taxonomy Codes

  • Taxonomy code: 175F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0409901 . This is a "WA STATE DEPT LABOR & INDUSTRY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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