Provider Demographics
NPI:1023484813
Name:A KWAN ACUPUNCTURE
Entity type:Organization
Organization Name:A KWAN ACUPUNCTURE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KWAN
Authorized Official - Suffix:
Authorized Official - Credentials:OMD, LAC
Authorized Official - Phone:805-294-0192
Mailing Address - Street 1:1534 N MOORPARK RD
Mailing Address - Street 2:STE 215
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5129
Mailing Address - Country:US
Mailing Address - Phone:805-294-0192
Mailing Address - Fax:866-543-8845
Practice Address - Street 1:223 E THOUSAND OAKS BLVD
Practice Address - Street 2:STE 216
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5803
Practice Address - Country:US
Practice Address - Phone:805-294-0192
Practice Address - Fax:866-543-8845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3369171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty