Provider Demographics
NPI:1619164472
Name:LIN, YI (LAC)
Entity Type:Individual
Prefix:MR
First Name:YI
Middle Name:
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 1:2911 BELLPORT AVE
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-4511
Mailing Address - Country:US
Mailing Address - Phone:516-468-0366
Mailing Address - Fax:
Practice Address - Street 1:5215 VAN LOON ST APT 1
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4228
Practice Address - Country:US
Practice Address - Phone:718-878-5217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003455171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist