MEDICARE: STEPHEN 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	5373	CA

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

General Provider Information

NPI Number	:	1407015803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN CHINN

Provider Business Mailing Address
First Line	:	45233 ANTARES DR BLDG 2660
Second Line	:	P.O.BOX 452134
City	:	SAN DIEGO
State	:	CA
Zip	:	92145-4426
Country	:	US
Telephone Number	:	858-695-7276
Fax Number	:	858-695-7378

Provider Business Practice Location Address
First Line	:	45233 ANTARES DR BLDG 2660
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92145-4426
Country	:	US
Telephone Number	:	858-695-7276
Fax Number	:	858-695-7378

Authorized Official
Title or Position	:	OWNER
Name	:	STEPHEN CHINN
Credential	:
Telephone Number	:	858-695-7276

Provider Enumeration Date	:	06/02/2008
Last Update Date	:	05/28/2010

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Directions to “STEPHEN CHINN ” Practice Location

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