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General NPI Number Information
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NPI Number | 1396163978
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Entity Type | Individual
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Provider Name | MELISSA Y KWAN
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Gender | Female
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Dates
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Enumeration Date | 04/01/2014
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Last Update Date | 06/27/2020
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Provider Practice Location Address
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Address Line | 17501 BISCAYNE BLVD STE 540
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City | AVENTURA
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State | FL
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Zip | 33160-4806
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Country | US
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Telephone | 888-972-9864
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Fax |
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Provider Business Mailing Address
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Address Line | 1360 SEABAY RD
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City | WESTON
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State | FL
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Zip | 33326-3326
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Country | US
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Telephone |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 0101267041
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME143959
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License Number State | FL
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