Provider Demographics
NPI:1609815406
Name:KWAN, PETER CK (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:CK
Last Name:KWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17510 W GRAND PKWY S STE 210
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2647
Mailing Address - Country:US
Mailing Address - Phone:281-725-5855
Mailing Address - Fax:281-725-5872
Practice Address - Street 1:17510 W GRAND PKWY S
Practice Address - Street 2:SUITE 210
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2645
Practice Address - Country:US
Practice Address - Phone:281-725-5855
Practice Address - Fax:281-725-5872
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5274207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139416502Medicaid
TX139416514Medicaid
TX139416502Medicaid
TXB24177Medicare UPIN
TX858521Medicare ID - Type Unspecified