Healthcare Provider Details

I. General information

NPI: 1730153131
Provider Name (Legal Business Name): CHIAN KENT KWOH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 E AJO WAY STE 103
TUCSON AZ
85713-6204
US

IV. Provider business mailing address

1501 N CAMPBELL AVE STE 8303
TUCSON AZ
85724-0001
US

V. Phone/Fax

Practice location:
  • Phone: 520-694-4000
  • Fax: 520-694-0635
Mailing address:
  • Phone: 520-626-4111
  • Fax: 520-626-2587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD035927E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number47927
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: