Provider Demographics
NPI:1720134141
Name:KWAN, MILDRED (MD)
Entity Type:Individual
Prefix:DR
First Name:MILDRED
Middle Name:
Last Name:KWAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 EASTOWNE DR FL 5
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2286
Mailing Address - Country:US
Mailing Address - Phone:984-974-2645
Mailing Address - Fax:984-974-2660
Practice Address - Street 1:100 EASTOWNE DR FL 5
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2286
Practice Address - Country:US
Practice Address - Phone:849-947-2645
Practice Address - Fax:984-974-2660
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD440182207K00000X
NC116373207RR0500X
NC2015-01709207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP953562OtherPHYSICIAN NUMBER
NC35356UMedicare UPIN