Provider Demographics
NPI:1932176609
Name:CHIN, EDWARD SANG (DPM)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:SANG
Last Name:CHIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:113 WATERWORKS WAY
Mailing Address - Street 2:SUITE 330
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3167
Mailing Address - Country:US
Mailing Address - Phone:949-450-0200
Mailing Address - Fax:949-450-0220
Practice Address - Street 1:16100 SAND CANYON AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3716
Practice Address - Country:US
Practice Address - Phone:949-450-0200
Practice Address - Fax:949-450-0220
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE3599213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E35990Medicaid
CAE3599Medicare ID - Type Unspecified
CA000E35990Medicaid