Provider Demographics
NPI:1518114859
Name:KWAN, DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:KWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 PLAIN ST
Mailing Address - Street 2:BAYSIDE BUILDING SUITE 501
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-3240
Mailing Address - Country:US
Mailing Address - Phone:401-444-5495
Mailing Address - Fax:401-444-2740
Practice Address - Street 1:235 PLAIN ST
Practice Address - Street 2:BAYSIDE BUILDING SUITE 501
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-3240
Practice Address - Country:US
Practice Address - Phone:401-444-5495
Practice Address - Fax:401-444-2740
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL1250481162086S0122X
RIMD14569208200000X
SD80792086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery