Provider Demographics
NPI:1891794152
Name:CHIN, STEFAN J (MD)
Entity Type:Individual
Prefix:
First Name:STEFAN
Middle Name:J
Last Name:CHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 SULLIVAN AVE
Mailing Address - Street 2:#520
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2221
Mailing Address - Country:US
Mailing Address - Phone:650-756-5000
Mailing Address - Fax:650-756-5903
Practice Address - Street 1:1850 SULLIVAN AVE
Practice Address - Street 2:#520
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2221
Practice Address - Country:US
Practice Address - Phone:650-756-5000
Practice Address - Fax:650-756-5903
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG83120207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0092050Medicaid
CAGR0092050Medicaid
100016188Medicare PIN
G78790Medicare UPIN