Healthcare Provider Details

I. General information

NPI: 1740103274
Provider Name (Legal Business Name): YICHUN LIN
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: SELINA LIN

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 N DIAMOND BAR BLVD STE B
DIAMOND BAR CA
91765-1059
US

IV. Provider business mailing address

22600 HICKORY NUT LN
DIAMOND BAR CA
91765-2513
US

V. Phone/Fax

Practice location:
  • Phone: 909-396-8900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: