Basic Information
| Provider Information | |||||||||
| NPI: | 1619181385 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHIN | ||||||||
| FirstName: | ALBERT | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSW, PPSC, MAHCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7600 E GRAVES AVE | ||||||||
| Address2: | #128 | ||||||||
| City: | ROSEMEAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262806510 | ||||||||
| FaxNumber: | 6262881026 | ||||||||
| Practice Location | |||||||||
| Address1: | 7600 E, GRAVES AVE. | ||||||||
| Address2: | |||||||||
| City: | ROSEMEAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6265373366 | ||||||||
| FaxNumber: | 6265690473 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 08/29/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | ASW14502 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 104100000X | ASW14502 | CA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.