Healthcare Provider Details

I. General information

NPI: 1265729412
Provider Name (Legal Business Name): VIVIAN LYNN CHIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 06/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVENUE BOX 49
BROOKLYN NY
11203-2098
US

IV. Provider business mailing address

450 CLARKSON AVENUE BOX 49
BROOKLYN NY
11203-2098
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-4714
  • Fax:
Mailing address:
  • Phone: 718-270-4714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number260081
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: