Provider Demographics
NPI:1902011992
Name:LIN, JANE Y (LAC)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:Y
Last Name:LIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:Y
Other - Last Name:KLEIMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:11352 BASKERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2928
Mailing Address - Country:US
Mailing Address - Phone:562-234-5005
Mailing Address - Fax:
Practice Address - Street 1:4132 KATELLA AVE STE 204
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-6601
Practice Address - Country:US
Practice Address - Phone:562-234-5005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 9310171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist