Healthcare Provider Details

I. General information

NPI: 1295091155
Provider Name (Legal Business Name): EDWARD C KUAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S MANCHESTER AVE STE 400
ORANGE CA
92868-3220
US

IV. Provider business mailing address

200 S MANCHESTER AVE STE 400
ORANGE CA
92868-3220
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-5753
  • Fax:
Mailing address:
  • Phone: 714-456-5753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA127918
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License NumberA127918
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: