Provider Demographics
NPI:1467428847
Name:WAH, JOHN CHIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHIN
Last Name:WAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:230 WEST BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301
Mailing Address - Country:US
Mailing Address - Phone:870-735-8246
Mailing Address - Fax:870-735-0481
Practice Address - Street 1:230 WEST BROADWAY
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301
Practice Address - Country:US
Practice Address - Phone:870-735-8246
Practice Address - Fax:870-735-0481
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2010-10-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARC6133207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR114933001Medicaid
C23044Medicare UPIN