Healthcare Provider Details

I. General information

NPI: 1184670481
Provider Name (Legal Business Name): WAYNE YUCK CHIN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 10/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20190 MARKET ST
ONANCOCK VA
23417-1330
US

IV. Provider business mailing address

20190 MARKET ST
ONANCOCK VA
23417-1330
US

V. Phone/Fax

Practice location:
  • Phone: 757-789-3402
  • Fax: 757-789-3862
Mailing address:
  • Phone: 757-789-3402
  • Fax: 757-789-3862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0103300934
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: