Provider Demographics
NPI:1003936196
Name:CHINO, ALLAN F
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:F
Last Name:CHINO
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:ALLAN
Other - Middle Name:F
Other - Last Name:CHINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:195 SW 144TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-5954
Mailing Address - Country:US
Mailing Address - Phone:503-705-7136
Mailing Address - Fax:
Practice Address - Street 1:195 SW 144TH AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-5954
Practice Address - Country:US
Practice Address - Phone:503-705-7136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1539103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA142511OtherL&I WORK COMP
NV2602063Medicaid
R23857Medicare UPIN
PHD298Medicare PIN