Healthcare Provider Details

I. General information

NPI: 1871173245
Provider Name (Legal Business Name): GUI LIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2021
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8616 WHITNEY AVE
ELMHURST NY
11373-3865
US

IV. Provider business mailing address

4602 70TH ST APT 8E
WOODSIDE NY
11377-6069
US

V. Phone/Fax

Practice location:
  • Phone: 718-651-6581
  • Fax:
Mailing address:
  • Phone: 904-263-0075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number062852
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: