Provider Demographics
NPI:1083680466
Name:CHIN, MICHAEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:CHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 G ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-5669
Mailing Address - Country:US
Mailing Address - Phone:530-741-1122
Mailing Address - Fax:530-741-1155
Practice Address - Street 1:414 G ST
Practice Address - Street 2:SUITE 208
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-5669
Practice Address - Country:US
Practice Address - Phone:530-741-1122
Practice Address - Fax:530-741-1155
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41895207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G418950OtherMEDICARE PTAN - FEATHER RIVER CARDIOLOGY
CA05D0968904OtherCLIA FEDERAL ID#
CA1083680466Medicaid
CA00G418950OtherBLUE SHIELD PIN #
CAA48730Medicare UPIN