Provider Demographics
NPI:1457300436
Name:MISSION SURGICAL CLINIC, INC.
Entity Type:Organization
Organization Name:MISSION SURGICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-278-8870
Mailing Address - Street 1:PO BOX 2828
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92878-2828
Mailing Address - Country:US
Mailing Address - Phone:951-278-8870
Mailing Address - Fax:951-278-8913
Practice Address - Street 1:7300 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-3849
Practice Address - Country:US
Practice Address - Phone:951-278-8870
Practice Address - Fax:951-278-8913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56529208600000X
CA20A10803208600000X
CAG75730208600000X
CA20A9434208600000X
CAPA16804363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G565290Medicaid
P80877Medicare UPIN
CA00G565290Medicaid
CAZZZ31134ZMedicare PIN