MEDICARE: DR. CLARENCE YL CHINN PROSTHODONTIST

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	1223P0700X	Prosthodontics	767	HI

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
2	17279	OTHER	HI	HMSA
3	76701	OTHER	HI	HDS

General Provider Information

NPI Number	:	1942311931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLARENCE YL CHINN PROSTHODONTIST

Provider Business Mailing Address
First Line	:	803 KAMEHAMEHA HWY
Second Line	:	SUITE 300
City	:	PEARL CITY
State	:	HI
Zip	:	96782-2638
Country	:	US
Telephone Number	:	808-455-7400
Fax Number	:	808-456-2622

Provider Business Practice Location Address
First Line	:	803 KAMEHAMEHA HWY
Second Line	:	SUITE 300
City	:	PEARL CITY
State	:	HI
Zip	:	96782-2638
Country	:	US
Telephone Number	:	808-455-7400
Fax Number	:	808-456-2622

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. CLARENCE YL CHINN PROSTHODONTIST” Practice Location

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