Healthcare Provider Details

I. General information

NPI: 1841998242
Provider Name (Legal Business Name): SHANSHAN LIN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2023
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 S ARROYO PKWY STE 420
PASADENA CA
91105-3215
US

IV. Provider business mailing address

675 S ARROYO PKWY STE 420
PASADENA CA
91105-3215
US

V. Phone/Fax

Practice location:
  • Phone: 925-282-1778
  • Fax:
Mailing address:
  • Phone: 925-282-1778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95025455
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95115422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: