Provider Demographics
NPI:1508038704
Name:KWAN, IRENE YI-XIAN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:YI-XIAN
Last Name:KWAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1353 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-3645
Mailing Address - Country:US
Mailing Address - Phone:510-608-4836
Mailing Address - Fax:
Practice Address - Street 1:1353 WASHINGTON AVE STE D2
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-3645
Practice Address - Country:US
Practice Address - Phone:510-608-4836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000342363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily