Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | J2535 | TX |
N | 208000000X | Pediatrician | J2535 | TX |
N | 2080P0203X | Pediatric Critical Care Doctor | J2535 | TX |
Y | 2080P0207X | Pediatric Hematology-Oncologist | J2535 | TX |
NPI | 1134186034 |
---|---|
Provider Name | Dr. Ka Wah Chan |
First Address | San Antonio, TX 78229-3311 |
Second Address | San Antonio, TX 78229-6306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 26/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
130467713 | (05) | TX |
130467714 | CSN (01) | TX |
8CC910 | BCBS (01) |