MEDICARE: DR. EDWIN K CHINN 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	MD13808	OR
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	MD00034381	WA

General Provider Information

NPI Number	:	1336152735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWIN K CHINN M.D.

Provider Business Mailing Address
First Line	:	13705 NE AIRPORT WAY
Second Line	:	SUITE C
City	:	PORTLAND
State	:	OR
Zip	:	97230-1048
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13705 NE AIRPORT WAY
Second Line	:	SUITE C
City	:	PORTLAND
State	:	OR
Zip	:	97230-1048
Country	:	US
Telephone Number	:	503-258-6854
Fax Number	:	503-258-6864

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	07/08/2007

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