Healthcare Provider Details

I. General information

NPI: 1225433295
Provider Name (Legal Business Name): WILLIAM H KWAN, DPM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2014
Last Update Date: 11/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PARROT LN
SIMI VALLEY CA
93065-3151
US

IV. Provider business mailing address

125 PARROT LN
SIMI VALLEY CA
93065-3151
US

V. Phone/Fax

Practice location:
  • Phone: 805-584-3668
  • Fax: 805-584-0016
Mailing address:
  • Phone: 805-584-3668
  • Fax: 805-584-0016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE2917
License Number StateCA

VIII. Authorized Official

Name: DR. WILLIAM H KWAN
Title or Position: OWNER
Credential: DPM
Phone: 805-584-3668