Healthcare Provider Details

I. General information

NPI: 1811758410
Provider Name (Legal Business Name): CHING-LAN LIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROSALINE LIN PH.D.

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 WESTWOOD PLZ
LOS ANGELES CA
90095-4103
US

IV. Provider business mailing address

4924 BALBOA BLVD # 175
ENCINO CA
91316-3402
US

V. Phone/Fax

Practice location:
  • Phone: 805-364-2012
  • Fax:
Mailing address:
  • Phone: 805-364-2012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPSY35123
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: