Provider Demographics
NPI:1316137722
Name:REN, QING (MD)
Entity type:Individual
Prefix:
First Name:QING
Middle Name:
Last Name:REN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12221 N MOPAC EXPY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2401
Mailing Address - Country:US
Mailing Address - Phone:512-805-0680
Mailing Address - Fax:512-805-0682
Practice Address - Street 1:1330 WONDER WORLD DR STE 101
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7567
Practice Address - Country:US
Practice Address - Phone:512-805-0680
Practice Address - Fax:512-805-0682
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.202116207RN0300X
VA0101240430207RN0300X
TXP7973207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX334817901Medicaid
TXP01393814OtherRRMDCR
MS01253061Medicaid
LA1006891Medicaid
P00739944Medicare PIN
LA1006891Medicaid
MS01253061Medicaid