Provider Demographics
NPI:1578527255
Name:CHIN, CORINA NGO (MD)
Entity Type:Individual
Prefix:DR
First Name:CORINA
Middle Name:NGO
Last Name:CHIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FOONG
Other - Middle Name:NGO
Other - Last Name:CHIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:19042 SOLEDAD CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91351-3362
Mailing Address - Country:US
Mailing Address - Phone:661-251-6300
Mailing Address - Fax:661-251-6303
Practice Address - Street 1:19042 SOLEDAD CANYON RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91351-3362
Practice Address - Country:US
Practice Address - Phone:661-251-6300
Practice Address - Fax:661-251-6303
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2012-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89287207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1766511Medicaid
I44878Medicare UPIN
TX1766511Medicaid