Provider Demographics
NPI:1790960011
Name:STEPHEN K KWAN M D INC
Entity Type:Organization
Organization Name:STEPHEN K KWAN M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:KAM-CHEUNG
Authorized Official - Last Name:KWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-680-0222
Mailing Address - Street 1:711 W COLLEGE ST
Mailing Address - Street 2:#200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-1163
Mailing Address - Country:US
Mailing Address - Phone:213-680-0222
Mailing Address - Fax:213-680-3603
Practice Address - Street 1:711 W COLLEGE ST
Practice Address - Street 2:#200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-1163
Practice Address - Country:US
Practice Address - Phone:213-680-0222
Practice Address - Fax:213-680-3603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-05
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35371207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA27765Medicare UPIN