Provider Demographics
NPI:1699409342
Name:LIN, SHAN JU (LAC (ACUPUNCTURIST))
Entity Type:Individual
Prefix:DR
First Name:SHAN JU
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:LAC (ACUPUNCTURIST)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MARBLEHEAD ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-7053
Mailing Address - Country:US
Mailing Address - Phone:805-522-3508
Mailing Address - Fax:
Practice Address - Street 1:7111 WINNETKA AVE STE 1
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-3673
Practice Address - Country:US
Practice Address - Phone:805-297-0632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-10
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15565171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist