Provider Demographics
NPI:1912006750
Name:KWAN, KEITH F (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:F
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 1:34 LONGBOW PLACE
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:ON
Mailing Address - Zip Code:N6G1Y3
Mailing Address - Country:CA
Mailing Address - Phone:519-685-8500
Mailing Address - Fax:
Practice Address - Street 1:LONDON HEALTH SERVICES CENTRE
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:LONDON
Practice Address - State:ON
Practice Address - Zip Code:NGA5A5
Practice Address - Country:CA
Practice Address - Phone:519-685-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA154261207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology