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General NPI Number Information
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NPI Number | 1164604294
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Entity Type | Organization
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Legal Business Name | CHUN WANG TAN MD PA
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Dates
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Enumeration Date | 11/30/2007
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Last Update Date | 11/30/2007
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Provider Practice Location Address
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Address Line | 323 W MULBERRY AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78212-3236
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Country | US
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Telephone | 210-731-0131
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Fax | 210-731-0131
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Provider Business Mailing Address
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Address Line | 323 W MULBERRY AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78212-3236
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Country | US
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Telephone | 210-731-0131
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Fax | 210-731-0131
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. CHUN WANG Y TAN
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Credential | MD
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Telephone | 210-731-0131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | K3862
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License Number State | TX
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