Provider Demographics
NPI:1194204669
Name:LIN, WAN-TING (LAC)
Entity Type:Individual
Prefix:
First Name:WAN-TING
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:SYLVIA
Other - Middle Name:
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16005 SIERRA PASS WAY
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-6538
Mailing Address - Country:US
Mailing Address - Phone:909-525-0536
Mailing Address - Fax:
Practice Address - Street 1:16005 SIERRA PASS WAY
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-6538
Practice Address - Country:US
Practice Address - Phone:909-525-0536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17043171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty