Provider Demographics
NPI:1770772568
Name:CHIN, SOPHIA (MD)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:CHIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 DEMPSTER ST
Mailing Address - Street 2:STE 360
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1186
Mailing Address - Country:US
Mailing Address - Phone:847-825-7030
Mailing Address - Fax:847-825-7047
Practice Address - Street 1:1875 DEMPSTER ST
Practice Address - Street 2:SUITE 360
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1186
Practice Address - Country:US
Practice Address - Phone:847-825-7030
Practice Address - Fax:847-825-7047
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.122928207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036122928Medicaid
IL456290001Medicare PIN