Provider Demographics
NPI:1497843122
Name:CHI, CARLIN LI-AN (MD)
Entity Type:Individual
Prefix:
First Name:CARLIN
Middle Name:LI-AN
Last Name:CHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1179 N MCDOWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-6559
Mailing Address - Country:US
Mailing Address - Phone:707-559-7500
Mailing Address - Fax:707-559-7570
Practice Address - Street 1:1179 N MCDOWELL BLVD
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-6559
Practice Address - Country:US
Practice Address - Phone:707-559-7500
Practice Address - Fax:707-559-7570
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2014-03-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA71794207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H87550Medicare UPIN