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General NPI Number Information
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NPI Number | 1134165467
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Entity Type | Individual
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Provider Name | STANLEY KWAN DEA M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 14445 OLIVE VIEW DR ROOM 2B-182
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City | SYLMAR
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State | CA
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Zip | 91342-1437
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Country | US
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Telephone | 818-364-3205
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Fax | 818-364-4627
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Provider Business Mailing Address
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Address Line | 6731 ANDOVER LN
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City | LOS ANGELES
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State | CA
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Zip | 90045-1096
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Country | US
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Telephone | 310-670-5192
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G072296
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License Number State | CA
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