Provider Demographics
NPI:1164670840
Name:LIN, CHUN MING (ND, RPH)
Entity Type:Individual
Prefix:DR
First Name:CHUN MING
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:ND, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5324 METROPOLITAN AVE
Mailing Address - Street 2:SUITE M1C (LOWER LEVEL)
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-1245
Mailing Address - Country:US
Mailing Address - Phone:866-800-2873
Mailing Address - Fax:866-244-1294
Practice Address - Street 1:5324 METROPOLITAN AVE
Practice Address - Street 2:SUITE M1C (LOWER LEVEL)
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-1245
Practice Address - Country:US
Practice Address - Phone:866-800-2873
Practice Address - Fax:866-244-1294
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA680175F00000X
CA220175F00000X
NY037945183500000X
WA15468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02633883Medicaid