Provider Demographics
NPI:1548224629
Name:CHIN, PHILIP LOU (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:LOU
Last Name:CHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11160 WARNER AVE
Mailing Address - Street 2:SUITE 421
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4008
Mailing Address - Country:US
Mailing Address - Phone:714-966-2009
Mailing Address - Fax:714-966-2372
Practice Address - Street 1:11160 WARNER AVE
Practice Address - Street 2:SUITE 421
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4008
Practice Address - Country:US
Practice Address - Phone:714-966-2009
Practice Address - Fax:714-966-2372
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80747174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G807470Medicaid
CAWG80747BMedicare ID - Type UnspecifiedMEDICARE PPIN
CA00G807470Medicaid