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General NPI Number Information
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NPI Number | 1073522314
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Entity Type | Organization
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Legal Business Name | KENNETH W. CHIN, M.D., INCORPORATED
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 09/28/2009
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Provider Practice Location Address
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Address Line | 16311 VENTURA BLVD SUITE120
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City | ENCINO
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State | CA
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Zip | 91436-2124
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Country | US
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Telephone | 818-817-7707
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Fax | 818-817-7727
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Provider Business Mailing Address
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Address Line | 16311 VENTURA BLVD SUITE120
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City | ENCINO
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State | CA
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Zip | 91436-2124
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Country | US
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Telephone | 818-817-7707
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Fax | 818-817-7727
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Authorized Official
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Title or Position | OWNER
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Name | KENNETH W CHIN
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Credential | M.D.
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Telephone | 818-705-0745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | G29660
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License Number State | CA
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