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General NPI Number Information
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NPI Number | 1699748541
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Entity Type | Organization
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Legal Business Name | SAN WAN, MDPC
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Dates
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Enumeration Date | 02/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 340 WOOD RD
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City | BRAINTREE
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State | MA
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Zip | 02184-2401
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Country | US
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Telephone | 781-849-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 8 WILDFLOWER LN
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City | WESTON
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State | MA
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Zip | 02493-1167
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Country | US
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Telephone | 781-647-9863
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SAN WAN
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Credential | M.D.
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Telephone | 781-647-9863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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