Healthcare Provider Details

I. General information

NPI: 1619637527
Provider Name (Legal Business Name): MARIHA KIJONE CHINN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2021
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11378 SHERMAN AVE
WARREN MI
48089-4041
US

IV. Provider business mailing address

33464 SCHOENHERR RD STE 180
STERLING HEIGHTS MI
48312-6392
US

V. Phone/Fax

Practice location:
  • Phone: 586-244-9813
  • Fax:
Mailing address:
  • Phone: 586-999-5971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: