Provider Demographics
NPI:1760269971
Name:CHIN, YE WON
Entity type:Individual
Prefix:DR
First Name:YE WON
Middle Name:
Last Name:CHIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 GREAT FALLS CT
Mailing Address - Street 2:STE 102
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545
Mailing Address - Country:US
Mailing Address - Phone:919-415-1855
Mailing Address - Fax:919-415-1849
Practice Address - Street 1:1101 GREAT FALLS CT
Practice Address - Street 2:STE 102
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545
Practice Address - Country:US
Practice Address - Phone:919-415-1855
Practice Address - Fax:919-415-1849
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC139991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1760269971Medicaid