Provider Demographics
NPI:1982839007
Name:LIN, CHENG WAN
Entity Type:Individual
Prefix:DR
First Name:CHENG WAN
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329A MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-3201
Mailing Address - Country:US
Mailing Address - Phone:718-938-0816
Mailing Address - Fax:718-744-5308
Practice Address - Street 1:329A MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-3201
Practice Address - Country:US
Practice Address - Phone:718-938-0816
Practice Address - Fax:718-744-5308
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052738183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist