Provider Demographics
NPI:1831505288
Name:CHIN, DAVID ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:CHIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1808 VERDUGO BLVD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1477
Mailing Address - Country:US
Mailing Address - Phone:818-790-6721
Mailing Address - Fax:818-790-6810
Practice Address - Street 1:1808 VERDUGO BLVD
Practice Address - Street 2:SUITE 312
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1477
Practice Address - Country:US
Practice Address - Phone:818-790-6721
Practice Address - Fax:818-790-6810
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA304261223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB-30426-01OtherDENTI-CAL