Provider Demographics
NPI:1730257338
Name:WING CHIN, M.D.
Entity type:Organization
Organization Name:WING CHIN, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:WING
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-886-2311
Mailing Address - Street 1:P. O. BOX 1145
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-1145
Mailing Address - Country:US
Mailing Address - Phone:510-886-2311
Mailing Address - Fax:510-886-9374
Practice Address - Street 1:20055 LAKE CHABOT RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5331
Practice Address - Country:US
Practice Address - Phone:510-886-2311
Practice Address - Fax:510-886-9374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC28239207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA33563Medicare UPIN