Provider Demographics
NPI:1306339098
Name:RAJOUB, LIN (DOCTOR)
Entity type:Individual
Prefix:
First Name:LIN
Middle Name:
Last Name:RAJOUB
Suffix:
Gender:F
Credentials:DOCTOR
Other - Prefix:
Other - First Name:LIN
Other - Middle Name:
Other - Last Name:RAJOUB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DOCTOR
Mailing Address - Street 1:9755 ALONDRA BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-3677
Mailing Address - Country:US
Mailing Address - Phone:310-483-3937
Mailing Address - Fax:
Practice Address - Street 1:9755 ALONDRA BLVD
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-3677
Practice Address - Country:US
Practice Address - Phone:714-423-5339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA103044122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty