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General NPI Number Information
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NPI Number | 1427283092
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Entity Type | Organization
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Legal Business Name | WESTERN ARIZONA CARDIOVASCULAR SURGERY PLLC
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Dates
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Enumeration Date | 05/26/2009
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Last Update Date | 08/31/2011
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Provider Practice Location Address
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Address Line | 1851 MESQUITE AVE SUITE 202
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5677
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Country | US
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Telephone | 928-854-0090
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Fax | 928-453-0671
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Provider Business Mailing Address
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Address Line | 8144 E CACTUS RD SUITE 800
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-5266
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Country | US
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Telephone | 480-596-8525
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Fax | 490-596-8522
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. CHRISTOPHER C KWON
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Credential | M.D.
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Telephone | 928-854-0090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 32875
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 32875
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License Number State | AZ
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