1316997729 NPI number — DR. POR KUNG LIN M.D.

Table of content: DR. POR KUNG LIN M.D. (NPI 1316997729)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316997729 NPI number — DR. POR KUNG LIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIN
Provider First Name:
POR KUNG
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LIN
Provider Other First Name:
PAUL
Provider Other Middle Name:
P.K.
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1316997729
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 SUMMIT PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITESTONE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11357-1047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-767-6786
Provider Business Mailing Address Fax Number:
718-767-6947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
136-68 UNIT 5A
Provider Second Line Business Practice Location Address:
ROOSEVELT AVE
Provider Business Practice Location Address City Name:
FLUSHING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-608-6969
Provider Business Practice Location Address Fax Number:
718-767-6947
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  113572 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00206693 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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