Individual
KENNY LIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
75 N COUNTRY ROAD, PORT JEFFERSON, NY 11777
(631) 476-2767
(631) 473-0132
Mailing address
75 N COUNTRY ROAD, PORT JEFFERSON, NY 11777
(631) 476-2767
(631) 473-0132
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
261820-I
NY
2085R0204X
Vascular & Interventional Radiology Physician
Primary
261820-I
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
261820-1
NEW YORK STATE LICENSE
NY
Enumeration date
04/18/2008
Last updated
08/31/2012
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