Healthcare Provider Details

I. General information

NPI: 1629736673
Provider Name (Legal Business Name): IRVIN MICHAEL KUAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

467 S BONNIE BRAE ST APT 306
LOS ANGELES CA
90057-4458
US

IV. Provider business mailing address

467 S BONNIE BRAE ST APT 306
LOS ANGELES CA
90057-4458
US

V. Phone/Fax

Practice location:
  • Phone: 626-537-8741
  • Fax:
Mailing address:
  • Phone: 626-537-8741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN287661
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95305063
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: