Provider Demographics
NPI:1477384451
Name:CHIN FAMILY CLINIC LLC
Entity type:Organization
Organization Name:CHIN FAMILY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAI
Authorized Official - Middle Name:SUNG
Authorized Official - Last Name:CHIN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:301-442-6914
Mailing Address - Street 1:7315 HENDERICKSON LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-2609
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7855 S EMERSON AVE STE D
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8669
Practice Address - Country:US
Practice Address - Phone:317-821-7800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-12
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service