Provider Demographics
NPI:1629736673
Name:KUAN, IRVIN MICHAEL
Entity Type:Individual
Prefix:
First Name:IRVIN MICHAEL
Middle Name:
Last Name:KUAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 S BONNIE BRAE ST APT 306
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-4458
Mailing Address - Country:US
Mailing Address - Phone:626-537-8741
Mailing Address - Fax:
Practice Address - Street 1:467 S BONNIE BRAE ST APT 306
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-4458
Practice Address - Country:US
Practice Address - Phone:626-537-8741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-07
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN287661164X00000X
CA95305063163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse