Provider Demographics
NPI:1912976291
Name:CHINN, STEPHEN
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:CHINN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2856 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-2930
Mailing Address - Country:US
Mailing Address - Phone:619-280-0664
Mailing Address - Fax:619-294-8100
Practice Address - Street 1:2856 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-2930
Practice Address - Country:US
Practice Address - Phone:619-280-0664
Practice Address - Fax:619-294-8100
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5373152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0053731Medicaid
CA0194850002Medicare NSC
CAOP5373Medicare UPIN
CAOP5373BMedicare UPIN
CAOP5373BMedicare PIN
CAOP5373Medicare PIN