Provider Demographics
NPI:1609237155
Name:LIN, FENNY KUAN (NP-C)
Entity Type:Individual
Prefix:
First Name:FENNY
Middle Name:KUAN
Last Name:LIN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 TOWN AND COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:PHILLIPS RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91766-6669
Mailing Address - Country:US
Mailing Address - Phone:626-736-3457
Mailing Address - Fax:
Practice Address - Street 1:2707 E VALLEY BLVD STE 116
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-3196
Practice Address - Country:US
Practice Address - Phone:626-581-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95003818363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily