Provider Demographics
NPI:1306190806
Name:CHIN, KENNETH P (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:P
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 1:555 CLYDE AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-2269
Mailing Address - Country:US
Mailing Address - Phone:650-988-6818
Mailing Address - Fax:
Practice Address - Street 1:555 CLYDE AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-2269
Practice Address - Country:US
Practice Address - Phone:650-988-6818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care