Healthcare Provider Details

I. General information

NPI: 1528012143
Provider Name (Legal Business Name): MARC CHIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10100 CULVER BLVD
CULVER CITY CA
90232-3175
US

IV. Provider business mailing address

4161 REDONDO BEACH BLVD SUITE 201
LAWNDALE CA
90260-3306
US

V. Phone/Fax

Practice location:
  • Phone: 310-280-2700
  • Fax: 310-837-7334
Mailing address:
  • Phone: 310-214-8677
  • Fax: 310-921-1718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA53354
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: