Provider Demographics
NPI:1659901254
Name:KERN COUNTY NEUROLOGICAL MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:KERN COUNTY NEUROLOGICAL MEDICAL GROUP, INC
Other - Org Name:ROWLAND HTS NEUROLOGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIAN
Authorized Official - Middle Name:CHENG
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-322-3008
Mailing Address - Street 1:1705 28TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-1902
Mailing Address - Country:US
Mailing Address - Phone:661-322-3008
Mailing Address - Fax:661-322-5507
Practice Address - Street 1:18645 GALE AVE STE 228B
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91748-1363
Practice Address - Country:US
Practice Address - Phone:661-322-3008
Practice Address - Fax:661-322-5507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-22
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ82875ZMedicaid