Provider Demographics
NPI:1780777037
Name:CHIN, VINCENT CHARLEY (MD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:CHARLEY
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 1:19411 NW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-3314
Mailing Address - Country:US
Mailing Address - Phone:305-653-5056
Mailing Address - Fax:305-652-2140
Practice Address - Street 1:19411 NW 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-3314
Practice Address - Country:US
Practice Address - Phone:305-653-5056
Practice Address - Fax:305-652-2140
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL35766207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD63573Medicare UPIN
FL95703Medicare ID - Type Unspecified