Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 1539 | OR |
Y | 103TC0700X | Clinical Psychologist | 1539 | OR |
NPI | 1003936196 |
---|---|
Provider Name | Dr. Allan F. Chino |
First Address | Beaverton, OR 97006-5954 |
Second Address | Beaverton, OR 97006-5954 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
142511 | L&I WORK COMP (01) | WA |
2602063 | (05) | NV |
R23857 | (02) |