Provider Demographics
NPI:1740390681
Name:CHIN, WARREN BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:BRUCE
Last Name:CHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2448 GUERNEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-4175
Mailing Address - Country:US
Mailing Address - Phone:707-575-5000
Mailing Address - Fax:707-575-5002
Practice Address - Street 1:2448 GUERNEVILLE RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-4175
Practice Address - Country:US
Practice Address - Phone:707-575-5000
Practice Address - Fax:707-575-5002
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75147208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA75147OtherSTATE LICENSE
CA00A751470OtherCIGNA DME
CAP00257421Medicare PIN
CAA75147OtherSTATE LICENSE
CA00A751470OtherCIGNA DME