Provider Demographics
NPI:1497407662
Name:CHIN, ALYSSA LYN
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:LYN
Last Name:CHIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 KULIOUOU RD
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-2434
Mailing Address - Country:US
Mailing Address - Phone:808-352-3340
Mailing Address - Fax:
Practice Address - Street 1:95-550 LANIKUHANA AVE
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-1783
Practice Address - Country:US
Practice Address - Phone:808-623-0702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI971152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist