Healthcare Provider Details

I. General information

NPI: 1215196092
Provider Name (Legal Business Name): PAUL CARL CHIN MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6767 LAKE WOODLANDS DR STE F
THE WOODLANDS TX
77382-2566
US

IV. Provider business mailing address

6767 LAKE WOODLANDS DR STE F
THE WOODLANDS TX
77382-2566
US

V. Phone/Fax

Practice location:
  • Phone: 281-364-1122
  • Fax:
Mailing address:
  • Phone: 281-364-1122
  • Fax: 281-210-2446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberN8173
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: