Provider Demographics
NPI:1962014613
Name:LIN, LINGYONG
Entity Type:Individual
Prefix:MR
First Name:LINGYONG
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:NEO
Other - Middle Name:
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:109 S ELECTRIC AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3195
Mailing Address - Country:US
Mailing Address - Phone:510-329-6019
Mailing Address - Fax:
Practice Address - Street 1:1985 ZONAL AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-5305
Practice Address - Country:US
Practice Address - Phone:323-442-1369
Practice Address - Fax:323-442-1681
Is Sole Proprietor?:No
Enumeration Date:2020-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46493390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program