Healthcare Provider Details

I. General information

NPI: 1336511328
Provider Name (Legal Business Name): TIMOTHY B KWAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2015
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8017 PICARDY AVE
BATON ROUGE LA
70809-3538
US

IV. Provider business mailing address

8017 PICARDY AVE
BATON ROUGE LA
70809-3538
US

V. Phone/Fax

Practice location:
  • Phone: 225-769-3636
  • Fax: 225-771-8047
Mailing address:
  • Phone: 225-769-3636
  • Fax: 225-771-8047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number300286
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: