MEDICARE: KRISTINA LIN BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1033761838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA LIN BCBA

Provider Business Mailing Address
First Line	:	910 KEENE DR
Second Line	:
City	:	LA HABRA
State	:	CA
Zip	:	90631-7148
Country	:	US
Telephone Number	:	714-386-8567
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 S FAIRFAX AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-2166
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2019
Last Update Date	:	11/23/2022

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