Provider Demographics
NPI:1578626271
Name:CHIN, DOUGLAS HOWARD
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:HOWARD
Last Name:CHIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DOUGLAS
Other - Middle Name:
Other - Last Name:CHIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:80 GRAND AVENUE
Mailing Address - Street 2:SUITE 810
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3729
Mailing Address - Country:US
Mailing Address - Phone:510-451-6950
Mailing Address - Fax:510-451-0785
Practice Address - Street 1:80 GRAND AVENUE
Practice Address - Street 2:SUITE 810
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3729
Practice Address - Country:US
Practice Address - Phone:510-451-6950
Practice Address - Fax:510-451-0785
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85671207XS0106X, 208200000X, 2082S0099X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG85671OtherSTATE MEDICAL LICENSE
CAH41660Medicare UPIN