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Organization
KENNETH W. CHIN, M.D., INCORPORATED
Active
Organization
KENNETH W. CHIN, M.D., INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH W CHIN M.D. (OWNER)
(818) 705-0745
Entity
Organization
Contact information
Practice address
16311 VENTURA BLVD, SUITE120, ENCINO, CA 91436-2124
(818) 817-7707
(818) 817-7727
Mailing address
16311 VENTURA BLVD, SUITE120, ENCINO, CA 91436-2124
(818) 817-7707
(818) 817-7727
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
G29660
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G296600
BLUE SHIELD
CA
05
—
00G296600
—
CA
05
—
GR0106039
—
CA
Enumeration date
08/05/2006
Last updated
09/28/2009
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