MEDICARE: DR. FENNEY KWAN MD

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
1	207V00000X	Obstetrics & Gynecology Physician	0101242201	VA

General Provider Information

NPI Number	:	1770656043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FENNEY KWAN MD

Provider Business Mailing Address
First Line	:	1181 FIRST COLONIAL RD
Second Line	:	SUITE 200
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2437
Country	:	US
Telephone Number	:	757-425-1600
Fax Number	:	757-425-6495

Provider Business Practice Location Address
First Line	:	1181 FIRST COLONIAL RD
Second Line	:	SUITE 200
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2437
Country	:	US
Telephone Number	:	757-425-1600
Fax Number	:	757-425-6495

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	03/02/2010

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