Provider Demographics
NPI:1801092101
Name:LIN, YI-JUN (MSTOM, LAC, MS, RD)
Entity type:Individual
Prefix:
First Name:YI-JUN
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:MSTOM, LAC, MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11015 LUCKY HORSESHOE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-1963
Mailing Address - Country:US
Mailing Address - Phone:704-763-7035
Mailing Address - Fax:
Practice Address - Street 1:8000 CORPORATE CENTER DR
Practice Address - Street 2:SUITE 212
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-4464
Practice Address - Country:US
Practice Address - Phone:704-763-7035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-23
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC400171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist