MEDICARE: CHUN WANG Y TAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	K3862	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8028M0	OTHER	TX	BCBS
3	8G9388	OTHER	TX	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104825785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHUN WANG Y TAN MD

Provider Business Mailing Address
First Line	:	1808 HIGHWAY 97 E
Second Line	:
City	:	JOURDANTON
State	:	TX
Zip	:	78026-1535
Country	:	US
Telephone Number	:	830-569-4003
Fax Number	:	830-569-4001

Provider Business Practice Location Address
First Line	:	1808 HIGHWAY 97 E
Second Line	:
City	:	JOURDANTON
State	:	TX
Zip	:	78026-1535
Country	:	US
Telephone Number	:	830-569-4003
Fax Number	:	830-569-4001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	10/14/2015

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Directions to “ CHUN WANG Y TAN MD” Practice Location

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