Provider Demographics
NPI:1821391996
Name:VINCENT C CHIN M.D., P.A.
Entity Type:Organization
Organization Name:VINCENT C CHIN M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:CHARLEY
Authorized Official - Last Name:CHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-653-5056
Mailing Address - Street 1:19411 NW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-3314
Mailing Address - Country:US
Mailing Address - Phone:305-653-5056
Mailing Address - Fax:305-652-2140
Practice Address - Street 1:19411 NW 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-3314
Practice Address - Country:US
Practice Address - Phone:305-653-5056
Practice Address - Fax:305-652-2140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL035766261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065607100Medicaid
FLD63573Medicare UPIN
FL95703Medicare PIN