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General NPI Number Information
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NPI Number | 1528901048
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Entity Type | Individual
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Provider Name | LINCOLN DEAN KROG
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Gender | Male
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Dates
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Enumeration Date | 04/10/2026
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Last Update Date | 04/10/2026
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Provider Practice Location Address
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Address Line | 1400 W FERN DR
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City | FULLERTON
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State | CA
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Zip | 92833-2331
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Country | US
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Telephone | 714-447-7710
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Fax |
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Provider Business Mailing Address
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Address Line | 731 E LAVENDER WAY
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City | AZUSA
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State | CA
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Zip | 91702-6294
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Country | US
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Telephone | 509-774-8299
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 22117
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License Number State | CA
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