Provider Demographics
NPI:1891788592
Name:KWAN, MARCUS R (MD)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:R
Last Name:KWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 SOQUEL DR
Mailing Address - Street 2:SUITE 340
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1719
Mailing Address - Country:US
Mailing Address - Phone:831-476-3322
Mailing Address - Fax:
Practice Address - Street 1:1595 SOQUEL DR
Practice Address - Street 2:SUITE 340
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1719
Practice Address - Country:US
Practice Address - Phone:831-476-3322
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA23018208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A230181Medicare ID - Type Unspecified
CAA23363Medicare UPIN