Healthcare Provider Details

I. General information

NPI: 1194412064
Provider Name (Legal Business Name): DAPHNE LIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 WORNALL RD STE 512
KANSAS CITY MO
64111-3235
US

IV. Provider business mailing address

901 E 104TH ST MAILSTOP 400S
KANSAS CITY MO
64131
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-8663
  • Fax:
Mailing address:
  • Phone: 816-932-8663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2024031317
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: