Provider Demographics
NPI:1659839926
Name:LIN, SUKWAH GRACE (MS, RDN)
Entity Type:Individual
Prefix:
First Name:SUKWAH
Middle Name:GRACE
Last Name:LIN
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W 6TH ST UNIT 848
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-6759
Mailing Address - Country:US
Mailing Address - Phone:808-256-9876
Mailing Address - Fax:
Practice Address - Street 1:529 E VALLEY BLVD STE 188B
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3683
Practice Address - Country:US
Practice Address - Phone:808-256-9876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered