Healthcare Provider Details

I. General information

NPI: 1982833547
Provider Name (Legal Business Name): QUAN LAN JASMINE LEW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2009
Last Update Date: 07/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST BOX 17
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

1000 W CARSON ST BOX 17
TORRANCE CA
90502-2004
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-2343
  • Fax: 310-222-2343
Mailing address:
  • Phone: 310-222-2343
  • Fax: 310-222-2343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2009015754
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: