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NPI Code Detail

MEDICARE: DR. LESLEY MAY KWAN O.D.

MEDICARE: DR. LESLEY MAY KWAN O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist13157TCA

General Provider Information

NPI Number : 1124142872
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LESLEY MAY KWAN O.D.
Provider Business Mailing Address
First Line : 263 ABOGADO AVE
Second Line :
City : WALNUT
State : CA
Zip : 91789-2502
Country : US
Telephone Number : 626-848-8188
Fax Number :
Provider Business Practice Location Address
First Line : 11301 WILSHIRE BLVD
Second Line : OPTOMETRY 123, RM 2118, BLDG 304
City : LOS ANGELES
State : CA
Zip : 90073-1003
Country : US
Telephone Number : 310-478-3711
Fax Number : 310-268-4918
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2007
Last Update Date : 12/01/2021

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