Provider Demographics
NPI:1942318084
Name:LIN, FAN MING (MD)
Entity Type:Individual
Prefix:
First Name:FAN MING
Middle Name:
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 1:13347 SANFORD AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5800
Mailing Address - Country:US
Mailing Address - Phone:718-461-9777
Mailing Address - Fax:
Practice Address - Street 1:13347 SANFORD AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5800
Practice Address - Country:US
Practice Address - Phone:718-461-9777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00780621Medicaid
NY85463Medicare ID - Type Unspecified
NY00780621Medicaid