Provider Demographics
NPI:1497495568
Name:LIN, NANG (MD)
Entity type:Individual
Prefix:
First Name:NANG
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15333 HUNTERS RIDGE LN
Practice Address - Street 2:
Practice Address - City:HUNTERTOWN
Practice Address - State:IN
Practice Address - Zip Code:46748-9814
Practice Address - Country:US
Practice Address - Phone:260-425-4870
Practice Address - Fax:260-458-8694
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01095789A207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program