Provider Demographics
NPI:1669766135
Name:JEN KIN, MYLES (DO)
Entity type:Individual
Prefix:DR
First Name:MYLES
Middle Name:
Last Name:JEN KIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 254
Mailing Address - Street 2:
Mailing Address - City:LUNENBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01462-0254
Mailing Address - Country:US
Mailing Address - Phone:512-666-1174
Mailing Address - Fax:
Practice Address - Street 1:9 VILLAGE INN RD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01473-1643
Practice Address - Country:US
Practice Address - Phone:978-223-9266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA262035207P00000X, 2083A0300X
MI5101019345207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110103483AMedicaid
MAS400226001Medicare PIN
MIA96008041Medicare PIN
MIC96038169Medicare PIN