Provider Demographics
NPI:1194119321
Name:CHIN, MICHAEL (LAC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:CHIN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2052 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2916
Mailing Address - Country:US
Mailing Address - Phone:917-647-7317
Mailing Address - Fax:
Practice Address - Street 1:40 PAMELA LN
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1424
Practice Address - Country:US
Practice Address - Phone:917-647-7317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25 002350171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist