Provider Demographics
NPI:1508154543
Name:KWAN, SIMEON MINGTACK (DO)
Entity Type:Individual
Prefix:
First Name:SIMEON
Middle Name:MINGTACK
Last Name:KWAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CENTURY BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3787
Mailing Address - Country:US
Mailing Address - Phone:615-454-9850
Mailing Address - Fax:
Practice Address - Street 1:5444 WESTHEIMER RD STE 1000
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-5318
Practice Address - Country:US
Practice Address - Phone:832-786-4970
Practice Address - Fax:855-722-0157
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA307102207QH0002X
AZ008714207QH0002X
NMDO2021-0022207QH0002X
MT104072207QH0002X
ORDO200808207QH0002X
CA20658207QH0002X
AK126216207QH0002X
UT12603369-1204207QH0002X
COCDR.0000536207QH0002X
WAOP61036685207QH0002X
NVCL0088207QH0002X
TXP4880207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX348533602Medicaid