Provider Demographics
NPI:1104985126
Name:CHIN, LEAH MUN (DDS)
Entity type:Individual
Prefix:DR
First Name:LEAH
Middle Name:MUN
Last Name:CHIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-3123
Mailing Address - Country:US
Mailing Address - Phone:310-328-9700
Mailing Address - Fax:310-328-9440
Practice Address - Street 1:1629 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-3123
Practice Address - Country:US
Practice Address - Phone:310-328-9700
Practice Address - Fax:310-328-9440
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA412881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice