Provider Demographics
NPI:1316997729
Name:LIN, POR KUNG (MD)
Entity type:Individual
Prefix:DR
First Name:POR KUNG
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PAUL
Other - Middle Name:PK
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4 SUMMIT PL
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1047
Mailing Address - Country:US
Mailing Address - Phone:718-767-6786
Mailing Address - Fax:718-767-6947
Practice Address - Street 1:136-68 UNIT 5A
Practice Address - Street 2:ROOSEVELT AVE
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:917-608-6969
Practice Address - Fax:718-767-6947
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113572207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00206693Medicaid
NY00206693Medicaid
87955AMedicare ID - Type Unspecified
H29528Medicare UPIN