Provider Demographics
NPI:1952523763
Name:LIN, FANG (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:FANG
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:FANG
Other - Middle Name:
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICENSED ACUPUNCTURI
Mailing Address - Street 1:5219 SOUTH KIMBARK AVE.
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615
Mailing Address - Country:US
Mailing Address - Phone:773-493-2923
Mailing Address - Fax:
Practice Address - Street 1:150 E HURON ST
Practice Address - Street 2:1100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2999
Practice Address - Country:US
Practice Address - Phone:312-926-3627
Practice Address - Fax:312-926-6285
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2016-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198-000103171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist