Healthcare Provider Details

I. General information

NPI: 1497077218
Provider Name (Legal Business Name): KATHLEEN CHIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2010
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 ENSIGN RD NE STE 220
OLYMPIA WA
98506-5063
US

IV. Provider business mailing address

PO BOX 3360
PORTLAND OR
97208-3360
US

V. Phone/Fax

Practice location:
  • Phone: 360-493-4015
  • Fax: 604-937-4723
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberMD61548569
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: