MEDICARE: KATHERINE CHIN LLC

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

General Provider Information

NPI Number	:	1760718894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATHERINE CHIN LLC

Provider Business Mailing Address
First Line	:	PO BOX 3701
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80155-3701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12046 E LAKE CIR
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-5253
Country	:	US
Telephone Number	:	303-250-8985
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KATHERINE CHIN
Credential	:
Telephone Number	:	303-250-8985

Provider Enumeration Date	:	10/24/2009
Last Update Date	:	11/02/2009

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