Healthcare Provider Details

I. General information

NPI: 1467175349
Provider Name (Legal Business Name): POLLY LIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15211 VANOWEN ST STE 300
VAN NUYS CA
91405-3617
US

IV. Provider business mailing address

541 W COLORADO ST STE 205
GLENDALE CA
91204-3640
US

V. Phone/Fax

Practice location:
  • Phone: 818-782-4104
  • Fax: 818-475-1823
Mailing address:
  • Phone: 323-794-1363
  • Fax: 323-488-9782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95021100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: