Healthcare Provider Details

I. General information

NPI: 1720910649
Provider Name (Legal Business Name): YUAN YUAN LIN RN BSN MEDSURG-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: YUANYUAN EVE LIN RN BSN MEDSURG-BC

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5645 MAIN ST
FLUSHING NY
11355-5045
US

IV. Provider business mailing address

5830 136TH ST FL 2
FLUSHING NY
11355-5205
US

V. Phone/Fax

Practice location:
  • Phone: 718-670-2170
  • Fax:
Mailing address:
  • Phone: 718-670-2170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number779887
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: