Provider Demographics
NPI:1356784391
Name:LI, LIN
Entity type:Individual
Prefix:
First Name:LIN
Middle Name:
Last Name:LI
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 1:3440 N ELSTON AVE
Mailing Address - Street 2:G1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-5640
Mailing Address - Country:US
Mailing Address - Phone:414-364-2317
Mailing Address - Fax:
Practice Address - Street 1:3440 N ELSTON AVE
Practice Address - Street 2:G1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-5640
Practice Address - Country:US
Practice Address - Phone:414-364-2317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program