Provider Demographics
NPI:1134291206
Name:CHIN, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
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:PO BOX 255228
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-5228
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:2800 L ST STE 600
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5616
Practice Address - Country:US
Practice Address - Phone:916-887-4040
Practice Address - Fax:916-887-4045
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39984207RI0011X, 207RC0000X, 207UN0901X, 207RA0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA060034807OtherRAILROAD MEDICARE
CAGR0068235Medicaid
CAGR0068235Medicaid
CAZZZ00967ZMedicare PIN
CAZZZ00968ZMedicare PIN
CAZZZ28052ZMedicare PIN
CAZZZ00966ZMedicare PIN
CAZZZ00965ZMedicare PIN
CAZZZ00967ZMedicare PIN
A48046Medicare UPIN
CAGR0068233Medicaid
CAGR0068235Medicaid
CAZZZ17828ZMedicare PIN
CA00G399840Medicaid
CAGR0068230Medicaid
CAGR0068231Medicaid
CAZZZ00968ZMedicare PIN
CAZZZ28052ZMedicare PIN
CAZZZ54665ZOtherBLUE SHIELD
00G399840Medicare ID - Type Unspecified