Provider Demographics
NPI:1164604294
Name:CHUN WANG TAN MD PA
Entity Type:Organization
Organization Name:CHUN WANG TAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUN WANG
Authorized Official - Middle Name:Y
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-731-0131
Mailing Address - Street 1:323 W MULBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-3236
Mailing Address - Country:US
Mailing Address - Phone:210-731-0131
Mailing Address - Fax:210-731-0131
Practice Address - Street 1:323 W MULBERRY AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-3236
Practice Address - Country:US
Practice Address - Phone:210-731-0131
Practice Address - Fax:210-731-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3862207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty