Provider Demographics
NPI:1871544890
Name:CHIN, MARIAN (PA-C)
Entity type:Individual
Prefix:MS
First Name:MARIAN
Middle Name:
Last Name:CHIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 STOCKTON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-2313
Mailing Address - Country:US
Mailing Address - Phone:415-982-2292
Mailing Address - Fax:415-982-3910
Practice Address - Street 1:770 STOCKTON ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-2313
Practice Address - Country:US
Practice Address - Phone:415-982-2292
Practice Address - Fax:415-982-3910
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12550363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS23780Medicare UPIN