Healthcare Provider Details

I. General information

NPI: 1104243229
Provider Name (Legal Business Name): KEVIN KWAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5141 BROADWAY
NEW YORK NY
10034-1159
US

IV. Provider business mailing address

622 W 168TH ST PH 111130
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 212-932-5067
  • Fax: 212-932-5097
Mailing address:
  • Phone: 212-305-5976
  • Fax: 212-305-6193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number285116
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: