Provider Demographics
NPI:1013903707
Name:CHIN, GEORGE SL (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:SL
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:PO BOX 22617
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-0617
Mailing Address - Country:US
Mailing Address - Phone:303-369-8088
Mailing Address - Fax:303-750-8899
Practice Address - Street 1:1550 S POTOMAC ST
Practice Address - Street 2:SUITE 235
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5455
Practice Address - Country:US
Practice Address - Phone:303-369-8088
Practice Address - Fax:303-750-8899
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30912174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04019980Medicaid
CO04019980Medicaid
COE91968Medicare UPIN