Provider Demographics
NPI:1013767367
Name:LIN, RAVEN LIPING (MD)
Entity Type:Individual
Prefix:
First Name:RAVEN
Middle Name:LIPING
Last Name:LIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2743 PEPPERDALE DR
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-4933
Mailing Address - Country:US
Mailing Address - Phone:909-910-2960
Mailing Address - Fax:
Practice Address - Street 1:1403 LOMITA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-2086
Practice Address - Country:US
Practice Address - Phone:310-602-2550
Practice Address - Fax:310-326-7205
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program