Provider Demographics
NPI:1629405832
Name:KWAN, TAO (LAC, PHD, DIPL OM)
Entity Type:Individual
Prefix:
First Name:TAO
Middle Name:
Last Name:KWAN
Suffix:
Gender:F
Credentials:LAC, PHD, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 93838
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91109-3838
Mailing Address - Country:US
Mailing Address - Phone:626-817-2896
Mailing Address - Fax:
Practice Address - Street 1:238 S ARROYO PKWY UNIT 140
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-4190
Practice Address - Country:US
Practice Address - Phone:626-817-2896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15224171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist