Provider Demographics
NPI:1093958464
Name:CHINH T. DINH, A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:CHINH T. DINH, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:KNOTT-BALL ANAHEIM MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHINH
Authorized Official - Middle Name:THIEN
Authorized Official - Last Name:DINH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-761-9137
Mailing Address - Street 1:3414 W BALL RD STE F
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3726
Mailing Address - Country:US
Mailing Address - Phone:714-761-9137
Mailing Address - Fax:
Practice Address - Street 1:3414 W BALL RD STE F
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3726
Practice Address - Country:US
Practice Address - Phone:714-761-9137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65428207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty