Provider Demographics
NPI:1104016526
Name:KWAN, STEPHEN K (DDS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:K
Last Name:KWAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 15TH STREET
Mailing Address - Street 2:SUITE 308
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404
Mailing Address - Country:US
Mailing Address - Phone:310-393-9706
Mailing Address - Fax:310-899-1828
Practice Address - Street 1:1304 15TH STREET
Practice Address - Street 2:SUITE 308
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404
Practice Address - Country:US
Practice Address - Phone:310-393-9706
Practice Address - Fax:310-899-1828
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA274461223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics