Provider Demographics
NPI:1013397611
Name:KWAN, ARTHUR (DMD)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:
Last Name:KWAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 BLUE OAKS BLVD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-7143
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1420 BLUE OAKS BLVD
Practice Address - Street 2:SUITE 180
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-7143
Practice Address - Country:US
Practice Address - Phone:916-780-9688
Practice Address - Fax:916-780-9698
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44913122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist