Provider Demographics
NPI:1811453004
Name:TIFFANY CHIN
Entity type:Organization
Organization Name:TIFFANY CHIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-381-8371
Mailing Address - Street 1:52 COLLEGE WAY
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-5001
Mailing Address - Country:US
Mailing Address - Phone:530-823-8353
Mailing Address - Fax:530-823-8355
Practice Address - Street 1:52 COLLEGE WAY
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-5001
Practice Address - Country:US
Practice Address - Phone:530-823-8353
Practice Address - Fax:530-823-8355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service