Provider Demographics
NPI:1992268718
Name:LIN, CYNTHIA SHAN
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:SHAN
Last Name:LIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42660 PHILADELPHIA PL
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-5531
Mailing Address - Country:US
Mailing Address - Phone:408-688-4998
Mailing Address - Fax:
Practice Address - Street 1:910 E HAMILTON AVE STE 110
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0612
Practice Address - Country:US
Practice Address - Phone:408-351-0382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-09
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000000OtherN/A