Healthcare Provider Details

I. General information

NPI: 1992642904
Provider Name (Legal Business Name): JESSIE LIN LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 9TH AVE STE 220
SAN FRANCISCO CA
94122-2373
US

IV. Provider business mailing address

1123 LINCOLN WAY
SAN FRANCISCO CA
94122-2112
US

V. Phone/Fax

Practice location:
  • Phone: 415-886-7851
  • Fax:
Mailing address:
  • Phone: 214-680-8856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC20314
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: