Basic Information
| Provider Information | |||||||||
| NPI: | 1366628273 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AN | ||||||||
| FirstName: | CHANG QING | ||||||||
| MiddleName: | |||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9102 FLOYD CURL DR | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782401553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2107829528 | ||||||||
| FaxNumber: | 5125970841 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 E QUINCY ST BSMT B100 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782152031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102998000 | ||||||||
| FaxNumber: | 2102998099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2008 | ||||||||
| LastUpdateDate: | 08/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 14093 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | 760675 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 218155401 | 05 | TX | MEDICAID |