Provider Demographics
NPI:1285795344
Name:CHING-CHUNG LIN
Entity type:Organization
Organization Name:CHING-CHUNG LIN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PIC
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-448-9884
Mailing Address - Street 1:10728 RAMONA BLVD
Mailing Address - Street 2:STE F
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2601
Mailing Address - Country:US
Mailing Address - Phone:626-448-9884
Mailing Address - Fax:626-448-5032
Practice Address - Street 1:10728 RAMONA BLVD
Practice Address - Street 2:STE F
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2601
Practice Address - Country:US
Practice Address - Phone:626-448-9884
Practice Address - Fax:626-448-5032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY455353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA455350Medicaid
1997695OtherPK
CAPHA455350Medicaid