Provider Demographics
NPI:1619163417
Name:CHIN, GARY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
Last Name:CHIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:GARY
Other - Middle Name:L
Other - Last Name:CHIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1130 140TH AVE NE STE 100B
Mailing Address - Street 2:1130 140TH AVE. NE, #100B
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2974
Mailing Address - Country:US
Mailing Address - Phone:425-746-6090
Mailing Address - Fax:425-747-9856
Practice Address - Street 1:1130 140TH AVE NE STE 100B
Practice Address - Street 2:1130 140TH AVE. NE, #100B
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2974
Practice Address - Country:US
Practice Address - Phone:425-746-6090
Practice Address - Fax:425-747-9856
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE9814122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist