Provider Demographics
NPI:1366628273
Name:AN, CHANG QING (NP)
Entity Type:Individual
Prefix:
First Name:CHANG QING
Middle Name:
Last Name:AN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9102 FLOYD CURL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1553
Mailing Address - Country:US
Mailing Address - Phone:210-782-9528
Mailing Address - Fax:512-597-0841
Practice Address - Street 1:215 E QUINCY ST BSMT B100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-2031
Practice Address - Country:US
Practice Address - Phone:210-299-8000
Practice Address - Fax:210-299-8099
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA14093363L00000X
TX760675363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX218155401Medicaid
TXTXB115255Medicare PIN