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NPI Code Detail

MEDICARE: WILSON KWAN M.D.

MEDICARE: WILSON KWAN M.D.
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
1207RC0000XCardiovascular Disease PhysicianA151616CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1972958775
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILSON KWAN M.D.
Provider Business Mailing Address
First Line : 2841 LOMITA BLVD STE 100
Second Line :
City : TORRANCE
State : CA
Zip : 90505-5100
Country : US
Telephone Number : 310-257-0508
Fax Number : 323-226-2657
Provider Business Practice Location Address
First Line : 2841 LOMITA BLVD STE 100
Second Line :
City : TORRANCE
State : CA
Zip : 90505-5100
Country : US
Telephone Number : 310-257-0508
Fax Number : 323-226-2657
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2016
Last Update Date : 07/13/2022

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Directions to “ WILSON KWAN M.D.” Practice Location

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