Provider Demographics
NPI:1073892501
Name:LIJIN, ANGELA SHILIN (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:SHILIN
Last Name:LIJIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14022 45TH AVE
Mailing Address - Street 2:APT# PLP
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3190
Mailing Address - Country:US
Mailing Address - Phone:646-318-8243
Mailing Address - Fax:
Practice Address - Street 1:14325 41ST AVE
Practice Address - Street 2:SUITE P2
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-1861
Practice Address - Country:US
Practice Address - Phone:718-321-2235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226479-1208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice