Provider Demographics
NPI:1689603466
Name:UM, CHANSINA (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHANSINA
Middle Name:
Last Name:UM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3 RICHLAND MEDICAL PARK DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6849
Mailing Address - Country:US
Mailing Address - Phone:803-807-9388
Mailing Address - Fax:803-807-9391
Practice Address - Street 1:3 RICHLAND MEDICAL PARK DR
Practice Address - Street 2:SUITE 110
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6849
Practice Address - Country:US
Practice Address - Phone:803-807-9388
Practice Address - Fax:803-807-9391
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCSC571213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE3898Medicaid
SCP05710Medicaid
SCV05171Medicare UPIN
SCP00329626Medicare PIN