Provider Demographics
NPI:1336125343
Name:CHINN, MELISSA S (DO)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:S
Last Name:CHINN
Suffix:
Gender:F
Credentials:DO
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 1407
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-1407
Mailing Address - Country:US
Mailing Address - Phone:360-824-5278
Mailing Address - Fax:888-281-2979
Practice Address - Street 1:111 S 12TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4000
Practice Address - Country:US
Practice Address - Phone:360-678-0831
Practice Address - Fax:360-678-0583
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001920207V00000X
WAOP00001921207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8426769Medicaid
WA8854519Medicare ID - Type Unspecified
WA8426769Medicaid