Provider Demographics
NPI:1720071434
Name:OEI, KWAN K (MD)
Entity Type:Individual
Prefix:DR
First Name:KWAN
Middle Name:K
Last Name:OEI
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 1:3110 GREENE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-2318
Mailing Address - Country:US
Mailing Address - Phone:817-926-3309
Mailing Address - Fax:817-921-6844
Practice Address - Street 1:3110 GREENE AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-2318
Practice Address - Country:US
Practice Address - Phone:817-926-3309
Practice Address - Fax:817-921-6844
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-27
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2828207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099397403Medicaid
TX099397403Medicaid
TX00325MMedicare PIN