Provider Demographics
NPI:1649382680
Name:KWAN, HEIDI Y (PHD)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:Y
Last Name:KWAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3585 MAPLE ST
Mailing Address - Street 2:STE 255
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-9147
Mailing Address - Country:US
Mailing Address - Phone:805-650-0657
Mailing Address - Fax:805-654-1098
Practice Address - Street 1:3585 MAPLE ST
Practice Address - Street 2:STE 255
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-9147
Practice Address - Country:US
Practice Address - Phone:805-650-0657
Practice Address - Fax:805-654-1098
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15019103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP15019AMedicare ID - Type Unspecified