Healthcare Provider Details

I. General information

NPI: 1366072654
Provider Name (Legal Business Name): TIMOTHY KUAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2020
Last Update Date: 01/25/2020
Certification Date: 01/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 FULL MOON
IRVINE CA
92618-8806
US

IV. Provider business mailing address

134 FULL MOON
IRVINE CA
92618-8806
US

V. Phone/Fax

Practice location:
  • Phone: 714-496-5976
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number95034022
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: