MEDICARE: DR. EDMUND H KWAN D.D.S., M.S.D., P.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	5161	WA

General Provider Information

NPI Number	:	1558467829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDMUND H KWAN D.D.S., M.S.D., P.S.

Provider Business Mailing Address
First Line	:	6715 FORT DENT WAY
Second Line	:
City	:	TUKWILA
State	:	WA
Zip	:	98188-2540
Country	:	US
Telephone Number	:	206-248-3330
Fax Number	:	206-431-1158

Provider Business Practice Location Address
First Line	:	6715 FORT DENT WAY
Second Line	:
City	:	TUKWILA
State	:	WA
Zip	:	98188-2540
Country	:	US
Telephone Number	:	206-248-3330
Fax Number	:	206-431-1158

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	07/08/2007

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