Provider Demographics
NPI:1902829450
Name:CHIN, RUBEN W (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:W
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 1:1717 W BALL RD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-5502
Mailing Address - Country:US
Mailing Address - Phone:714-776-7006
Mailing Address - Fax:714-776-7666
Practice Address - Street 1:1717 W BALL RD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-5502
Practice Address - Country:US
Practice Address - Phone:714-776-7006
Practice Address - Fax:714-776-7666
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53452207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA201570217OtherEMPLOYER ID
CA00A534520Medicaid
CA00A534520Medicaid
CA201570217OtherEMPLOYER ID