MEDICARE: DR. LEO P. CHIN D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	11575	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174731657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEO P. CHIN D.M.D.

Provider Business Mailing Address
First Line	:	5020 GUNN HWY
Second Line	:	#200
City	:	TAMPA
State	:	FL
Zip	:	33624-6379
Country	:	US
Telephone Number	:	813-264-7006
Fax Number	:	813-264-6072

Provider Business Practice Location Address
First Line	:	5020 GUNN HWY
Second Line	:	#200
City	:	TAMPA
State	:	FL
Zip	:	33624-6379
Country	:	US
Telephone Number	:	813-264-7006
Fax Number	:	813-264-6072

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	07/08/2007

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