Provider Demographics
NPI:1356070999
Name:LIN, PHON JON
Entity Type:Individual
Prefix:
First Name:PHON JON
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4511 LUCKSINGER LN TRLR 8
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-2046
Mailing Address - Country:US
Mailing Address - Phone:512-905-8869
Mailing Address - Fax:
Practice Address - Street 1:4511 LUCKSINGER LN TRLR 8
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-2046
Practice Address - Country:US
Practice Address - Phone:512-905-8869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01913171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist