Provider Demographics
NPI:1710097191
Name:KWAN, WILLIAM H (DPM)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:H
Last Name:KWAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 PARROT LN
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-3151
Mailing Address - Country:US
Mailing Address - Phone:805-584-3668
Mailing Address - Fax:805-584-0016
Practice Address - Street 1:125 PARROT LN
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-3151
Practice Address - Country:US
Practice Address - Phone:805-584-3668
Practice Address - Fax:805-584-0016
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2013-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2917213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E29170Medicaid
CA4898110001Medicare NSC
CAE2917Medicare PIN
CA000E29170Medicaid