Provider Demographics
NPI:1427097286
Name:CHINN, DARYL H (MD)
Entity type:Individual
Prefix:
First Name:DARYL
Middle Name:H
Last Name:CHINN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6102
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94948-6102
Mailing Address - Country:US
Mailing Address - Phone:415-884-3418
Mailing Address - Fax:415-883-8082
Practice Address - Street 1:347 ANDRIEUX ST
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6811
Practice Address - Country:US
Practice Address - Phone:707-935-5235
Practice Address - Fax:415-883-8082
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG415142085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00280852OtherRAILROAD MEDICARE
CA00G415140OtherBLUE SHIELD
CA00G415140Medicaid
CA00G415141OtherBLUE SHIELD OF CA
CAAZ359KMedicare PIN
CAWG41514AMedicare PIN
CAAZ359LMedicare PIN
P00280852OtherRAILROAD MEDICARE
A48592Medicare UPIN
CA00G415140Medicaid
CABL291ZMedicare PIN
CAAZ359MMedicare PIN
CAAZ359QMedicare PIN
CAAZ359ZMedicare PIN
CA00G415140Medicare PIN
CA00G415140OtherBLUE SHIELD