Provider Demographics
NPI:1790897098
Name:CHEN, KRISTIN SHOUHWA (DA LAC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:SHOUHWA
Last Name:CHEN
Suffix:
Gender:F
Credentials:DA LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2827 ROCKY OAK ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1839
Mailing Address - Country:US
Mailing Address - Phone:210-496-3943
Mailing Address - Fax:210-496-3943
Practice Address - Street 1:15600 SAN PEDRO
Practice Address - Street 2:SUITE 307
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232
Practice Address - Country:US
Practice Address - Phone:210-496-0936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00470171100000X
RIDA00166171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11487288OtherCAQH
0017LQOtherBCBS