Provider Demographics
NPI:1013072073
Name:CHIN, ALVIN (MD)
Entity type:Individual
Prefix:
First Name:ALVIN
Middle Name:
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 1:12610 GLENOAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-4783
Mailing Address - Country:US
Mailing Address - Phone:818-361-4111
Mailing Address - Fax:818-361-7584
Practice Address - Street 1:12610 GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-4783
Practice Address - Country:US
Practice Address - Phone:818-361-4111
Practice Address - Fax:818-361-7584
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44112174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A441120Medicaid
CA00A441120Medicaid