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1912249970 NPI number — CHARISSE CHIN D.O.

NPI Number: 1912249970
Health Care Provider/Practitioner: CHARISSE CHIN D.O.

Information about “1912249970” NPI (CHARISSE CHIN D.O.) exists in 1912249970 in HTML format HTML  |  1912249970 in plain Text format TXT  |  1912249970 in PDF (Portable Document Format) PDF  |  1912249970 in an XML format XML  formats.

NPI Number : 1912249970 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1912249970",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CHIN",
    "FirstName": "CHARISSE",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "D.O.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1821 N WEBB RD STE 201",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WICHITA",
    "MailingAddressStateName": "KS",
    "MailingAddressPostalCode": "67206-3435",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "316-684-5158",
    "MailingAddressFaxNumber": "316-681-1005",
    "FirstLinePracticeLocationAddress": "1821 N WEBB RD STE 201",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WICHITA",
    "PracticeLocationAddressStateName": "KS",
    "PracticeLocationAddressPostalCode": "67206-3435",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "316-684-5158",
    "PracticeLocationAddressFaxNumber": "316-681-1005",
    "EnumerationDate": "03/18/2013",
    "LastUpdateDate": "09/23/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207W00000X",
          "TaxonomyName": "Ophthalmology Physician",
          "LicenseNumber": "20A16338",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207W00000X",
          "TaxonomyName": "Ophthalmology Physician",
          "LicenseNumber": "05-51708",
          "LicenseNumberStateCode": "KS",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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