Provider Demographics
NPI:1003886227
Name:WAUKEGAN DIALYSIS ASSOCIATES PTR KANG YANN LIN GEN PTR
Entity Type:Organization
Organization Name:WAUKEGAN DIALYSIS ASSOCIATES PTR KANG YANN LIN GEN PTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEPHROLOGY PHYSICIAN & INTERNAL MED
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:FREELAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-623-0032
Mailing Address - Street 1:1616 GRAND AVE
Mailing Address - Street 2:STE A
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085
Mailing Address - Country:US
Mailing Address - Phone:847-623-0032
Mailing Address - Fax:847-623-0505
Practice Address - Street 1:1616 GRAND AVE
Practice Address - Street 2:STE A
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085
Practice Address - Country:US
Practice Address - Phone:847-623-0032
Practice Address - Fax:847-623-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036049794Medicaid
IL716300Medicare PIN