Provider Demographics
NPI:1760795041
Name:LIN, SHIH-CHUNG (RPH)
Entity Type:Individual
Prefix:
First Name:SHIH-CHUNG
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:21083 TOPAZ LN
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4042
Mailing Address - Country:US
Mailing Address - Phone:909-839-0526
Mailing Address - Fax:
Practice Address - Street 1:2150 S ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-6839
Practice Address - Country:US
Practice Address - Phone:323-726-0385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 39076183500000X
NV08735183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV08735OtherPHARMACIST LICENSE NO
CARPH 39076OtherPHARMACIST LICENSE NO