Healthcare Provider Details

I. General information

NPI: 1841922499
Provider Name (Legal Business Name): LI YING LIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 4TH ST STE A
SAN RAFAEL CA
94901-5716
US

IV. Provider business mailing address

4344 KISSENA BLVD APT 11G
FLUSHING NY
11355-3757
US

V. Phone/Fax

Practice location:
  • Phone: 415-448-1500
  • Fax:
Mailing address:
  • Phone: 704-779-1027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDH34697
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: