Provider Demographics
NPI:1295148179
Name:BAW, CHIN-KUN (MD)
Entity type:Individual
Prefix:
First Name:CHIN-KUN
Middle Name:
Last Name:BAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WILLY
Other - Middle Name:CHIN-KUN
Other - Last Name:BAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3495 PIEDMONT RD NE BLDG 9 3RD FLOOR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1736
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3495 PIEDMONT RD NE BLDG 9 3RD FLOOR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1736
Practice Address - Country:US
Practice Address - Phone:404-949-5183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA77939207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine