Provider Demographics
NPI:1184632044
Name:LIEN, JUNG CHIN (MD)
Entity type:Individual
Prefix:MR
First Name:JUNG
Middle Name:CHIN
Last Name:LIEN
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 1:149 GRAPE ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601
Mailing Address - Country:US
Mailing Address - Phone:325-676-7000
Mailing Address - Fax:325-676-9469
Practice Address - Street 1:149 GRAPE ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601
Practice Address - Country:US
Practice Address - Phone:325-676-7000
Practice Address - Fax:325-676-9469
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5621207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097959301Medicaid
B24385Medicare UPIN
TX097959301Medicaid