Provider Demographics
NPI:1932393162
Name:LIN, CELIA JOW FANG (MD)
Entity type:Individual
Prefix:DR
First Name:CELIA
Middle Name:JOW FANG
Last Name:LIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CELIA
Other - Middle Name:JOW
Other - Last Name:FANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:BOX 8045
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:925-786-8122
Mailing Address - Fax:
Practice Address - Street 1:1800 S BRENTWOOD BLVD
Practice Address - Street 2:#1116
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144-1820
Practice Address - Country:US
Practice Address - Phone:925-786-8122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006001771207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology