MEDICARE: PHON JON LIN

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	171100000X	Acupuncturist	AC01913	TX

General Provider Information

NPI Number	:	1356070999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHON JON LIN

Provider Business Mailing Address
First Line	:	4511 LUCKSINGER LN TRLR 8
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-2046
Country	:	US
Telephone Number	:	512-905-8869
Fax Number	:

Provider Business Practice Location Address
First Line	:	4511 LUCKSINGER LN TRLR 8
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-2046
Country	:	US
Telephone Number	:	512-905-8869
Fax Number	:

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

Provider Enumeration Date	:	06/08/2022
Last Update Date	:	06/08/2022

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Directions to “ PHON JON LIN ” Practice Location

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