Healthcare Provider Details

I. General information

NPI: 1023513645
Provider Name (Legal Business Name): DAVID TIAN CHIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 DEMPSTER ST STE AIP
PARK RIDGE IL
60068-1143
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1285
US

V. Phone/Fax

Practice location:
  • Phone: 800-655-2656
  • Fax: 412-822-7411
Mailing address:
  • Phone: 847-390-5900
  • Fax: 412-822-7411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number036170596
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA166652
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: