Provider Demographics
NPI:1437859717
Name:KWAN, SUKBUN LOUISA
Entity Type:Individual
Prefix:
First Name:SUKBUN
Middle Name:LOUISA
Last Name:KWAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MANHATTAN CT
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94065-8429
Mailing Address - Country:US
Mailing Address - Phone:650-200-3818
Mailing Address - Fax:
Practice Address - Street 1:501 SEAPORT COURT ( MOVE: 505 SEAPORT COURT ON 4/1/23)
Practice Address - Street 2:SUITE 104(MOVE: SUITE 102 ON 4/1/2023)
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063
Practice Address - Country:US
Practice Address - Phone:650-200-3818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18888225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist