Provider Demographics
NPI:1871282608
Name:LIN, WILLIAM PENGDA
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PENGDA
Last Name:LIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:YING
Other - Middle Name:
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3811 SCHAEFER AVE STE J
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5400
Mailing Address - Country:US
Mailing Address - Phone:909-591-0888
Mailing Address - Fax:
Practice Address - Street 1:3811 SCHAEFER AVE STE J
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-5400
Practice Address - Country:US
Practice Address - Phone:909-591-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19748171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty