Provider Demographics
NPI:1487614830
Name:CHIN, EDWIN SY (MD)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:SY
Last Name:CHIN
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 66596
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98166-0596
Mailing Address - Country:US
Mailing Address - Phone:206-937-3262
Mailing Address - Fax:206-938-7621
Practice Address - Street 1:16122 8TH AVE SW STE E2
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2967
Practice Address - Country:US
Practice Address - Phone:206-937-3262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00034331207R00000X, 207RN0300X
ORMD23813207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8204083Medicaid
WAG8851019OtherMEDICARE GROUP PIN
WAG8850808Medicare PIN
WAG8851019OtherMEDICARE GROUP PIN