Provider Demographics
NPI:1114998754
Name:LIN, MIN CHUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:MIN
Middle Name:CHUNG
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7603 ROUTE 54
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-7930
Mailing Address - Country:US
Mailing Address - Phone:607-776-0163
Mailing Address - Fax:607-776-8032
Practice Address - Street 1:7603 ROUTE 54
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-7930
Practice Address - Country:US
Practice Address - Phone:607-776-0163
Practice Address - Fax:607-776-8032
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125455-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00452231Medicaid
PA0015240220001Medicaid
NY160053540OtherRR MEDICARE PIN
NYCC8362OtherRR MEDICARE GROUP
NYCC2070Medicare ID - Type Unspecified
PA0015240220001Medicaid