Provider Demographics
NPI:1265830277
Name:DAI, LIN
Entity Type:Individual
Prefix:
First Name:LIN
Middle Name:
Last Name:DAI
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:PO BOX 640324
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-0324
Mailing Address - Country:US
Mailing Address - Phone:917-353-2617
Mailing Address - Fax:
Practice Address - Street 1:6136 SPRINGFIELD BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-2336
Practice Address - Country:US
Practice Address - Phone:917-353-2617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-08
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI0559501183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist