Provider Demographics
NPI:1558467829
Name:KWAN, EDMUND H (DDS, MSD, PS)
Entity Type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:H
Last Name:KWAN
Suffix:
Gender:M
Credentials:DDS, MSD, PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6715 FORT DENT WAY
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2540
Mailing Address - Country:US
Mailing Address - Phone:206-248-3330
Mailing Address - Fax:206-431-1158
Practice Address - Street 1:6715 FORT DENT WAY
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2540
Practice Address - Country:US
Practice Address - Phone:206-248-3330
Practice Address - Fax:206-431-1158
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA51611223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics