Healthcare Provider Details

I. General information

NPI: 1477795300
Provider Name (Legal Business Name): IRENE IYING LIN R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10833 LE CONTE AVE 32-231 CHS
LOS ANGELES CA
90095-3075
US

IV. Provider business mailing address

4900 W SUNSET BLVD FL 3
LOS ANGELES CA
90027-5814
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-6581
  • Fax: 310-206-8616
Mailing address:
  • Phone: 323-783-6970
  • Fax: 323-783-0113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number883209
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: