Provider Demographics
NPI:1619601416
Name:KWAN, KEVIN O (RN, MSN, AGACNP)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:O
Last Name:KWAN
Suffix:
Gender:M
Credentials:RN, MSN, AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 E HEATHER CIR
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-1480
Mailing Address - Country:US
Mailing Address - Phone:323-600-4373
Mailing Address - Fax:
Practice Address - Street 1:713 E HEATHER CIR
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-1480
Practice Address - Country:US
Practice Address - Phone:323-600-4373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021695363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care