Healthcare Provider Details

I. General information

NPI: 1881663904
Provider Name (Legal Business Name): SHU YAIN CHIN M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 12/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 BOWERY 6F
NEW YORK NY
10013-4615
US

IV. Provider business mailing address

86 BOWERY 6F
NEW YORK NY
10013-4615
US

V. Phone/Fax

Practice location:
  • Phone: 212-219-9175
  • Fax: 212-219-9176
Mailing address:
  • Phone: 212-219-9175
  • Fax: 212-219-9176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number193825
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: