Provider Demographics
NPI:1720360837
Name:KWAN, WINNIE
Entity Type:Individual
Prefix:MS
First Name:WINNIE
Middle Name:
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 1:6100 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-2001
Mailing Address - Country:US
Mailing Address - Phone:650-992-3900
Mailing Address - Fax:650-992-4192
Practice Address - Street 1:6100 MISSION ST
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-2001
Practice Address - Country:US
Practice Address - Phone:650-992-3900
Practice Address - Fax:650-992-4192
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56480183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist