Healthcare Provider Details

I. General information

NPI: 1225812258
Provider Name (Legal Business Name): HYOSUK CHIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BRIAN CHIN

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S EUCLID AVE MSC 8109-22-9905
SAINT LOUIS MO
63110-1010
US

IV. Provider business mailing address

660 S EUCLID AVE MSC 8109-22-9905
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-8028
  • Fax:
Mailing address:
  • Phone: 314-362-8028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number2023007538
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: