Provider Demographics
NPI:1962522706
Name:JIN, SIU LIN (OMD LAC)
Entity type:Individual
Prefix:
First Name:SIU LIN
Middle Name:
Last Name:JIN
Suffix:
Gender:F
Credentials:OMD LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3523 W OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-3502
Mailing Address - Country:US
Mailing Address - Phone:323-733-8887
Mailing Address - Fax:
Practice Address - Street 1:3523 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-3502
Practice Address - Country:US
Practice Address - Phone:323-733-8887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 9445171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC9445Medicare UPIN