Provider Demographics
NPI:1952521197
Name:LE, LIN
Entity Type:Individual
Prefix:
First Name:LIN
Middle Name:
Last Name:LE
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 1:4457 TEMECULA ST
Mailing Address - Street 2:UNIT 105
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-1072
Mailing Address - Country:US
Mailing Address - Phone:619-255-2082
Mailing Address - Fax:
Practice Address - Street 1:4457 TEMECULA ST
Practice Address - Street 2:UNIT 105
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-1072
Practice Address - Country:US
Practice Address - Phone:619-255-2082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 201850164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVN 201850OtherLVN LICENSE