Provider Demographics
NPI:1912681479
Name:LIN, CHIA JOANNE
Entity Type:Individual
Prefix:
First Name:CHIA
Middle Name:JOANNE
Last Name:LIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22520 59TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2340
Mailing Address - Country:US
Mailing Address - Phone:718-551-6642
Mailing Address - Fax:718-551-6642
Practice Address - Street 1:22520 59TH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-2340
Practice Address - Country:US
Practice Address - Phone:718-551-6642
Practice Address - Fax:718-551-6642
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2516112174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist