Provider Demographics
NPI:1639483746
Name:KWAN, MELINDA (DO)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:KWAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-838-8265
Mailing Address - Fax:
Practice Address - Street 1:2845 SIENA HEIGHTS DR STE 1100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4161
Practice Address - Country:US
Practice Address - Phone:702-669-5840
Practice Address - Fax:702-650-5729
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO1809207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1639483746Medicaid
NVP01386897OtherRAILROAD MEDICARE
NV1639483746OtherMEDICAID SMA CONVENIENT CARE
NVV106802OtherMEDICARE SMACC
NVV106754Medicare PIN