Provider Demographics
NPI:1437876414
Name:LONGEVITY CLINICS & RESEARCH INSTITUTE
Entity Type:Organization
Organization Name:LONGEVITY CLINICS & RESEARCH INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR & CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-255-9755
Mailing Address - Street 1:400 E LIVE OAK AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-5619
Mailing Address - Country:US
Mailing Address - Phone:626-662-0288
Mailing Address - Fax:
Practice Address - Street 1:400 E LIVE OAK AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-5619
Practice Address - Country:US
Practice Address - Phone:626-662-0288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEGGroup - Single Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty