Healthcare Provider Details

I. General information

NPI: 1295699379
Provider Name (Legal Business Name): SAMUEL HERMAN CHINN PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 159TH ST
TINLEY PARK IL
60477-1758
US

IV. Provider business mailing address

6701 159TH ST STE 2
TINLEY PARK IL
60477-1758
US

V. Phone/Fax

Practice location:
  • Phone: 888-824-0200
  • Fax:
Mailing address:
  • Phone: 708-798-9465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209034181
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: