1134186034 NPI number — DR. KA WAH CHAN M.D.

Table of content: DR. KA WAH CHAN M.D. (NPI 1134186034)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134186034 NPI number — DR. KA WAH CHAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAN
Provider First Name:
KA WAH
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134186034
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8109 FREDERICKSBURG RD
Provider Second Line Business Mailing Address:
PHYSICIAN PRACTICE SERVICES
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78229-3311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-575-2222
Provider Business Mailing Address Fax Number:
210-575-6373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4410 MEDICAL DR
Provider Second Line Business Practice Location Address:
SUITE 550
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-6306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-575-2222
Provider Business Practice Location Address Fax Number:
210-575-6373
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0000X , with the licence number:  J2535 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: J2535 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0203X , with the licence number: J2535 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0207X , with the licence number: J2535 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8CC910 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 130467713 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 130467714 . This is a "CSN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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