Healthcare Provider Details

I. General information

NPI: 1790897098
Provider Name (Legal Business Name): KRISTIN SHOUHWA CHEN DA LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15600 SAN PEDRO SUITE 307
SAN ANTONIO TX
78232
US

IV. Provider business mailing address

2827 ROCKY OAK ST
SAN ANTONIO TX
78232-1839
US

V. Phone/Fax

Practice location:
  • Phone: 210-496-0936
  • Fax:
Mailing address:
  • Phone: 210-496-3943
  • Fax: 210-496-3943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00470
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberDA00166
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: