Provider Demographics
NPI:1912249970
Name:CHIN, CHARISSE (DO)
Entity type:Individual
Prefix:DR
First Name:CHARISSE
Middle Name:
Last Name:CHIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 N WEBB RD STE 201
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3435
Mailing Address - Country:US
Mailing Address - Phone:316-684-5158
Mailing Address - Fax:316-681-1005
Practice Address - Street 1:1821 N WEBB RD STE 201
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3435
Practice Address - Country:US
Practice Address - Phone:316-684-5158
Practice Address - Fax:316-681-1005
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A16338207W00000X
KS05-51708207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology