Healthcare Provider Details

I. General information

NPI: 1457432692
Provider Name (Legal Business Name): PAUL B. CHIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 CALIFORNIA DR
YOUNTVILLE CA
94599-1412
US

IV. Provider business mailing address

435 ESTADO WAY
NOVATO CA
94945-1305
US

V. Phone/Fax

Practice location:
  • Phone: 707-944-4716
  • Fax:
Mailing address:
  • Phone: 707-944-4716
  • Fax: 707-944-5052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA24517
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: