Provider Demographics
NPI:1952849127
Name:CHIN, SAMUEL (LPT)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:CHIN
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2550 E FOOTHILL BLVD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3406
Mailing Address - Country:US
Mailing Address - Phone:187-772-2273
Mailing Address - Fax:626-844-0481
Practice Address - Street 1:2550 E FOOTHILL BLVD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3406
Practice Address - Country:US
Practice Address - Phone:187-772-2273
Practice Address - Fax:626-844-0481
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA38378167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician