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General NPI Number Information
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NPI Number | 1669104816
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Entity Type | Individual
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Provider Name | KEVIN SWAN
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Gender | Male
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Dates
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Enumeration Date | 06/27/2022
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Last Update Date | 08/12/2024
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Provider Practice Location Address
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Address Line | 255 TERRACINA BLVD STE 210
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City | REDLANDS
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State | CA
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Zip | 92373-4870
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Country | US
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Telephone | 909-792-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 255 TERRACINA BLVD STE 210
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City | REDLANDS
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State | CA
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Zip | 92373-4870
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Country | US
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Telephone | 909-792-8500
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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 | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | HA8810
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License Number State | CA
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