Healthcare Provider Details

I. General information

NPI: 1578626271
Provider Name (Legal Business Name): DOUGLAS HOWARD CHIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DOUGLAS CHIN M.D.

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 GRAND AVENUE SUITE 810
OAKLAND CA
94612-3729
US

IV. Provider business mailing address

80 GRAND AVENUE SUITE 810
OAKLAND CA
94612-3729
US

V. Phone/Fax

Practice location:
  • Phone: 510-451-6950
  • Fax: 510-451-0785
Mailing address:
  • Phone: 510-451-6950
  • Fax: 510-451-0785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberG85671
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG85671
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberG85671
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberG85671
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: