Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | G62156 | CA |
NPI | 1285744672 |
---|---|
Provider Name | Mark Chin |
First Address | Fresno, CA 93710-5207 |
Second Address | Fresno, CA 93710-5207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 01/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G21560 | (05) | CA |
F65014 | (02) | CA |