MEDICARE: ELIAS NICOLAS KIWAN M.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
1	207R00000X	Internal Medicine Physician	E-3479	AR
2	208M00000X	Hospitalist Physician	E-3479	AR
3	207RH0003X	Hematology & Oncology Physician	C54469	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790875276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIAS NICOLAS KIWAN M.D.

Provider Business Mailing Address
First Line	:	10470 OLD PLACERVILLE RD
Second Line	:	SUITE 100
City	:	SACRAMENTO
State	:	CA
Zip	:	95827-2539
Country	:	US
Telephone Number	:	800-470-0071
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 29TH STREET
Second Line	:	SUITE 680
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-5124
Country	:	US
Telephone Number	:	916-453-3300
Fax Number	:	916-453-3313

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	08/17/2015

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