Healthcare Provider Details

I. General information

NPI: 1730541707
Provider Name (Legal Business Name): LINGYUN DU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2438 N PONDEROSA DR STE C105
CAMARILLO CA
93010-2465
US

IV. Provider business mailing address

PO BOX 5127
EVERETT WA
98206-5127
US

V. Phone/Fax

Practice location:
  • Phone: 805-388-2068
  • Fax: 805-484-7700
Mailing address:
  • Phone: 206-401-3142
  • Fax: 206-401-3201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD61016144
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA167622
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: