Provider Demographics
NPI:1194369694
Name:CHING, ENOCH (CCP)
Entity Type:Individual
Prefix:
First Name:ENOCH
Middle Name:
Last Name:CHING
Suffix:
Gender:M
Credentials:CCP
Other - Prefix:MR
Other - First Name:ENOCH
Other - Middle Name:
Other - Last Name:CHING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCP
Mailing Address - Street 1:7215 SPRING FLOWER ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2608
Mailing Address - Country:US
Mailing Address - Phone:210-687-7935
Mailing Address - Fax:
Practice Address - Street 1:3463 MAGIC DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2973
Practice Address - Country:US
Practice Address - Phone:210-614-8101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0000208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0000OtherN/A