=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730024357
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIA CHIN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2026
-----------------------------------------------------
Last Update Date | 04/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 302 PERIMETER CTR N
-----------------------------------------------------
City | DUNWOODY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30346-2488
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-564-4679
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1454 BURYCOVE CIR
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30043-6229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-564-4679
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MT012403
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------