Healthcare Provider Details

I. General information

NPI: 1407317829
Provider Name (Legal Business Name): RYAN LAURENCE CHIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 11/30/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 MAPLE AVE FL 9
WHITE PLAINS NY
10601-4706
US

IV. Provider business mailing address

122 MAPLE AVE
WHITE PLAINS NY
10601-4706
US

V. Phone/Fax

Practice location:
  • Phone: 914-681-0600
  • Fax:
Mailing address:
  • Phone: 914-681-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD0101128
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: