Provider Demographics
NPI:1629252259
Name:LIN, TA-JEN (EAMP, LAC)
Entity Type:Individual
Prefix:MR
First Name:TA-JEN
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:EAMP, LAC
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:EAMP, LAC
Mailing Address - Street 1:13401 BEL RED RD STE A12
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2322
Mailing Address - Country:US
Mailing Address - Phone:425-392-8881
Mailing Address - Fax:425-633-2166
Practice Address - Street 1:13401 BEL RED RD STE A12
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2322
Practice Address - Country:US
Practice Address - Phone:425-392-8881
Practice Address - Fax:425-633-2166
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00003003171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist