Provider Demographics
NPI:1265797005
Name:LIN, JENNY PEICHEN (MS)
Entity type:Individual
Prefix:MS
First Name:JENNY
Middle Name:PEICHEN
Last Name:LIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 E WORKMAN ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3655
Mailing Address - Country:US
Mailing Address - Phone:626-512-0627
Mailing Address - Fax:
Practice Address - Street 1:770 S BREA BLVD
Practice Address - Street 2:SUITE #213
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5360
Practice Address - Country:US
Practice Address - Phone:714-529-9274
Practice Address - Fax:714-529-9276
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-11-8149103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst