Provider Demographics
NPI:1235410325
Name:LIN, DIANA CHUN (LAC, DAOM)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:CHUN
Last Name:LIN
Suffix:
Gender:F
Credentials:LAC, DAOM
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:CHUN
Other - Last Name:CHANG-CHIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC, DAOM
Mailing Address - Street 1:PO BOX 932
Mailing Address - Street 2:
Mailing Address - City:SWANSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28584-0932
Mailing Address - Country:US
Mailing Address - Phone:650-670-1118
Mailing Address - Fax:
Practice Address - Street 1:99 VILLAGE DR
Practice Address - Street 2:SUITE 16
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7067
Practice Address - Country:US
Practice Address - Phone:650-670-1118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC580171100000X
CAAC11892171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist