Healthcare Provider Details

I. General information

NPI: 1962492181
Provider Name (Legal Business Name): GRACE ENCARNACION CHIN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 TELEGRAPH AVE
OAKLAND CA
94609-2009
US

IV. Provider business mailing address

4881 TELEGRAPH AVE
OAKLAND CA
94609-2009
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3316
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number8940
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number110865
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS038115
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number22DI02267701
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number22DI02267700
License Number StateNJ
# 6
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number049650
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: