MEDICARE: DR. MARK DERRICK CHIN-LENN M.D.

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	207Q00000X	Family Medicine Physician	ME89650	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	ME89650	OTHER	FL	MEDICAL LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265477509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK DERRICK CHIN-LENN M.D.

Provider Business Mailing Address
First Line	:	4040 SHERIDAN ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3536
Country	:	US
Telephone Number	:	954-322-7166
Fax Number	:	954-322-7169

Provider Business Practice Location Address
First Line	:	4040 SHERIDAN ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3536
Country	:	US
Telephone Number	:	954-322-7166
Fax Number	:	954-322-7169

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

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	03/07/2023

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