Provider Demographics
NPI:1740528082
Name:KWONG, HAU SHAN
Entity type:Individual
Prefix:
First Name:HAU SHAN
Middle Name:
Last Name:KWONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 NEW AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3735
Mailing Address - Country:US
Mailing Address - Phone:626-320-6023
Mailing Address - Fax:
Practice Address - Street 1:509 N CORDOVA ST
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-2714
Practice Address - Country:US
Practice Address - Phone:626-320-6023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19111363A00000X
CA584306363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant