Healthcare Provider Details

I. General information

NPI: 1659901254
Provider Name (Legal Business Name): KERN COUNTY NEUROLOGICAL MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18645 GALE AVE STE 228B
CITY OF INDUSTRY CA
91748-1363
US

IV. Provider business mailing address

1705 28TH ST
BAKERSFIELD CA
93301-1902
US

V. Phone/Fax

Practice location:
  • Phone: 661-322-3008
  • Fax: 661-322-5507
Mailing address:
  • Phone: 661-322-3008
  • Fax: 661-322-5507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number
License Number State

VIII. Authorized Official

Name: JIAN CHENG LIN
Title or Position: PRESIDENT
Credential: MD
Phone: 661-322-3008