Healthcare Provider Details

I. General information

NPI: 1821488545
Provider Name (Legal Business Name): KELIN MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2015
Last Update Date: 02/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5303 8TH AVE
BROOKLYN NY
11220-3201
US

IV. Provider business mailing address

150 MYRTLE AVE APT 504
BROOKLYN NY
11201-2911
US

V. Phone/Fax

Practice location:
  • Phone: 312-933-5621
  • Fax:
Mailing address:
  • Phone: 312-933-5621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number263245
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number263245
License Number StateNY

VIII. Authorized Official

Name: DR. CONGRONG LIN
Title or Position: MD, PHD
Credential:
Phone: 312-933-5621