MEDICARE: EDWIN ANTHONY CHIN DDS

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	122300000X	Dentist	15706	TX

General Provider Information

NPI Number	:	1356546303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWIN ANTHONY CHIN DDS

Provider Business Mailing Address
First Line	:	3010 LITTLE YORK RD
Second Line	:	3010 LITTLE YORK
City	:	HOUSTON
State	:	TX
Zip	:	77093-3520
Country	:	US
Telephone Number	:	713-574-5159
Fax Number	:

Provider Business Practice Location Address
First Line	:	3010 LITTLE YORK RD
Second Line	:	3010 LITTLE YORK
City	:	HOUSTON
State	:	TX
Zip	:	77093-3520
Country	:	US
Telephone Number	:	713-574-5159
Fax Number	:

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

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	07/09/2007

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