Provider Demographics
NPI:1124052576
Name:CHIN, WING (MD)
Entity type:Individual
Prefix:
First Name:WING
Middle Name:
Last Name:CHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1145
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-1145
Mailing Address - Country:US
Mailing Address - Phone:510-886-2311
Mailing Address - Fax:510-886-9374
Practice Address - Street 1:20055 LAKE CHABOT RD
Practice Address - Street 2:#300
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5331
Practice Address - Country:US
Practice Address - Phone:510-886-2311
Practice Address - Fax:510-886-9374
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC28239207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC29239OtherSTATE LICENCE #
CAC29239OtherSTATE LICENCE #
CAAW1332042OtherDEA #
CAC29239OtherSTATE LICENCE #