Provider Demographics
NPI:1568351047
Name:SWAIN, KURT
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:
Last Name:SWAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S PARK AVE STE 780
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-1553
Mailing Address - Country:US
Mailing Address - Phone:626-465-8002
Mailing Address - Fax:
Practice Address - Street 1:300 S PARK AVE STE 780
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-1553
Practice Address - Country:US
Practice Address - Phone:626-465-8002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-QUIHOC175T00000X
CA15126C1C55171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171400000XOther Service ProvidersHealth & Wellness Coach