Provider Demographics
NPI:1437560810
Name:CHIN, EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:CHIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 WASHINGTON ST
Mailing Address - Street 2:STE 102
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-9183
Mailing Address - Country:US
Mailing Address - Phone:360-389-3198
Mailing Address - Fax:866-501-0671
Practice Address - Street 1:2141 WASHINGTON ST
Practice Address - Street 2:STE 102
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248
Practice Address - Country:US
Practice Address - Phone:360-389-3198
Practice Address - Fax:866-501-0671
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00009485122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist