Provider Demographics
NPI:1992352074
Name:CHIN, MAI SUNG (FNP-C)
Entity type:Individual
Prefix:
First Name:MAI
Middle Name:SUNG
Last Name:CHIN
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7855 S EMERSON AVE STE D
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8669
Mailing Address - Country:US
Mailing Address - Phone:317-821-7800
Mailing Address - Fax:317-891-5900
Practice Address - Street 1:7855 S EMERSON AVE STE D
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8669
Practice Address - Country:US
Practice Address - Phone:301-442-6914
Practice Address - Fax:317-891-5900
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-22
Last Update Date:2025-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28223255C363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1992352074Medicaid