Provider Demographics
NPI:1639649189
Name:KWAN, ANDREA LEE
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEE
Last Name:KWAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 LAKE CAROLYN PKWY APT 3348
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-4800
Mailing Address - Country:US
Mailing Address - Phone:214-250-0730
Mailing Address - Fax:
Practice Address - Street 1:1050 LAKE CAROLYN PKWY APT 3348
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-4800
Practice Address - Country:US
Practice Address - Phone:214-250-0730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant