Provider Demographics
NPI:1265454821
Name:CHINN, GARY G
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:G
Last Name:CHINN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4218 92ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:YARROW POINT
Mailing Address - State:WA
Mailing Address - Zip Code:98004-1323
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1717 S J ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4933
Practice Address - Country:US
Practice Address - Phone:253-426-4101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00021899207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
108154OtherL&I
G16667OtherB/S REGENCE 90
G16667OtherB/S REGENCE 90
8114365Medicare ID - Type Unspecified