Provider Demographics
NPI:1497908495
Name:WILLIAMS, KYNAN DEWAN (MD)
Entity Type:Individual
Prefix:
First Name:KYNAN
Middle Name:DEWAN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:122 W JOHN CARPENTER FWY STE 420
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2014
Mailing Address - Country:US
Mailing Address - Phone:972-957-3000
Mailing Address - Fax:972-957-3005
Practice Address - Street 1:2959 S BUCKNER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-6945
Practice Address - Country:US
Practice Address - Phone:214-206-4974
Practice Address - Fax:214-206-4979
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN4845207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8X8692OtherBLUE CROSS BLUE SHIELD
TX209013601Medicaid
TX8L22614Medicare PIN