Provider Demographics
NPI:1043578321
Name:JI, LIN
Entity Type:Individual
Prefix:
First Name:LIN
Middle Name:
Last Name:JI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13630 MAPLE AVE STE 2F
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3867
Mailing Address - Country:US
Mailing Address - Phone:516-806-2288
Mailing Address - Fax:718-750-9634
Practice Address - Street 1:13630 MAPLE AVE STE 2F
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3867
Practice Address - Country:US
Practice Address - Phone:516-806-2288
Practice Address - Fax:718-750-9634
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY286502207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04598087Medicaid