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General NPI Number Information
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NPI Number | 1831181114
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Entity Type | Individual
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Provider Name | FREDRIC K. CHIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/22/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 350 HAWTHORNE AVE
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City | OAKLAND
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State | CA
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Zip | 94609-3108
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Country | US
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Telephone | 510-869-6588
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Fax | 510-869-6179
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Provider Business Mailing Address
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Address Line | 411 HAWTHORNE AVE
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City | OAKLAND
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State | CA
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Zip | 94609-3031
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Country | US
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Telephone | 510-869-6251
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Fax | 510-869-6250
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | C28230
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License Number State | CA
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