MEDICARE: JENNIFER CHINN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	15407	CA

General Provider Information

NPI Number	:	1073989471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER CHINN

Provider Business Mailing Address
First Line	:	PO BOX 9256
Second Line	:
City	:	RANCHO SANTA FE
State	:	CA
Zip	:	92067-4256
Country	:	US
Telephone Number	:	858-525-3094
Fax Number	:

Provider Business Practice Location Address
First Line	:	2811 UNIVERSITY AVE
Second Line	:	C
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-2904
Country	:	US
Telephone Number	:	619-280-0664
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2015
Last Update Date	:	08/19/2015

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Directions to “ JENNIFER CHINN ” Practice Location

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