=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235410325
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIANA CHUN LIN L.AC., DAOM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2011
-----------------------------------------------------
Last Update Date | 09/01/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 99 VILLAGE DR SUITE 16
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28546-7067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-670-1118
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 932
-----------------------------------------------------
City | SWANSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28584-0932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-670-1118
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 580
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC11892
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------