Healthcare Provider Details

I. General information

NPI: 1831700632
Provider Name (Legal Business Name): KATHRYN CHINN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date: 08/19/2020
Reactivation Date: 12/15/2020

III. Provider practice location address

3030 WESTCHESTER AVE
PURCHASE NY
10577-2574
US

IV. Provider business mailing address

800 WESTCHESTER AVE STE N715
RYE BROOK NY
10573-1369
US

V. Phone/Fax

Practice location:
  • Phone: 914-848-8960
  • Fax: 914-848-8965
Mailing address:
  • Phone: 914-607-5730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: