Provider Demographics
NPI:1669675419
Name:CHIN, AMBER MARIE (PA)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:MARIE
Last Name:CHIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 BROWNING ST
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-1318
Mailing Address - Country:US
Mailing Address - Phone:909-981-5725
Mailing Address - Fax:
Practice Address - Street 1:12739 N OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-2320
Practice Address - Country:US
Practice Address - Phone:909-803-8550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008171363A00000X
CAPA17916363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant