Provider Demographics
NPI:1477795300
Name:LIN, IRENE IYING (RD)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:IYING
Last Name:LIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 W SUNSET BLVD FL 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5814
Mailing Address - Country:US
Mailing Address - Phone:323-783-6970
Mailing Address - Fax:323-783-0113
Practice Address - Street 1:10833 LE CONTE AVE
Practice Address - Street 2:32-231 CHS
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-3075
Practice Address - Country:US
Practice Address - Phone:310-206-6581
Practice Address - Fax:310-206-8616
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA883209133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered