Healthcare Provider Details

I. General information

NPI: 1154825552
Provider Name (Legal Business Name): JUSTIN JEREMIAH CHIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 10/27/2026
Certification Date: 10/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 CELANESE RD
ROCK HILL SC
29732-8408
US

IV. Provider business mailing address

2960 CELANESE RD
ROCK HILL SC
29732-8408
US

V. Phone/Fax

Practice location:
  • Phone: 803-328-3828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number201902726
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number201902726
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number95495
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number95495
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: