Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 12053 | MT |
NPI | 1003047960 |
---|---|
Provider Name | Dr. Kevin Matthew Chin |
First Address | Missoula, MT 59802-4123 |
Second Address | Missoula, MT 59802-4123 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2009 |
Last Update Date | 07/01/2010 |