Provider Demographics
NPI:1346581212
Name:LIN, JUSTIN Y (LAC)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:Y
Last Name:LIN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9955 LOWER AZUSA RD
Mailing Address - Street 2:#101
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-4059
Mailing Address - Country:US
Mailing Address - Phone:626-688-9999
Mailing Address - Fax:
Practice Address - Street 1:9955 LOWER AZUSA RD
Practice Address - Street 2:#101
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780-4059
Practice Address - Country:US
Practice Address - Phone:626-688-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-02
Last Update Date:2013-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12810171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist