Healthcare Provider Details

I. General information

NPI: 1881721926
Provider Name (Legal Business Name): STEPHEN KWANSIA SU D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 E CHAPMAN
ORANGE CA
92866-1620
US

IV. Provider business mailing address

P.O. BOX 2517
ANAHEIM CA
92814-0517
US

V. Phone/Fax

Practice location:
  • Phone: 714-532-6357
  • Fax: 714-532-4144
Mailing address:
  • Phone: 714-532-6357
  • Fax: 714-532-4144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE2174
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: