Provider Demographics
NPI:1821488545
Name:KELIN MEDICAL PC
Entity Type:Organization
Organization Name:KELIN MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD, PHD
Authorized Official - Prefix:DR
Authorized Official - First Name:CONGRONG
Authorized Official - Middle Name:
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-933-5621
Mailing Address - Street 1:150 MYRTLE AVE APT 504
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-2911
Mailing Address - Country:US
Mailing Address - Phone:312-933-5621
Mailing Address - Fax:
Practice Address - Street 1:5303 8TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3201
Practice Address - Country:US
Practice Address - Phone:312-933-5621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263245261Q00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No282N00000XHospitalsGeneral Acute Care Hospital