Provider Demographics
NPI:1326005968
Name:CHINN, JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:CHINN
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 1:22832 102ND PL W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-5131
Mailing Address - Country:US
Mailing Address - Phone:206-795-4186
Mailing Address - Fax:
Practice Address - Street 1:1551 NW 54TH
Practice Address - Street 2:STE 101
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107
Practice Address - Country:US
Practice Address - Phone:206-789-1828
Practice Address - Fax:206-789-1829
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD0010955207Y00000X
WAMD00010955207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1040104Medicaid
G000100904Medicare ID - Type Unspecified
WA1040104Medicaid