MEDICARE: MS. KATHLEEN CHIN 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	207VF0040X	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician	MD61548569	WA

General Provider Information

NPI Number	:	1497077218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN CHIN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 3360
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3360
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3425 ENSIGN RD NE STE 220
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-5063
Country	:	US
Telephone Number	:	360-493-4015
Fax Number	:	604-937-4723

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

Provider Enumeration Date	:	02/20/2010
Last Update Date	:	02/13/2025

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