Healthcare Provider Details

I. General information

NPI: 1992628101
Provider Name (Legal Business Name): NIKO LIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6759 W CHARLESTON BLVD STE 110
LAS VEGAS NV
89146-2000
US

IV. Provider business mailing address

9264 SIMON ST
LAS VEGAS NV
89166-6826
US

V. Phone/Fax

Practice location:
  • Phone: 949-506-6162
  • Fax:
Mailing address:
  • Phone: 702-290-8016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number831916
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: