Provider Demographics
NPI:1992837496
Name:CHIN, JEROME HSI-CHENG (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:HSI-CHENG
Last Name:CHIN
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:95 MONTGOMERY DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-6630
Mailing Address - Country:US
Mailing Address - Phone:707-576-1461
Mailing Address - Fax:707-576-0648
Practice Address - Street 1:95 MONTGOMERY DR
Practice Address - Street 2:SUITE 102
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-6630
Practice Address - Country:US
Practice Address - Phone:707-576-1461
Practice Address - Fax:707-576-0648
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG658512084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G658511Medicaid
F26514Medicare UPIN
CA00G658511Medicaid