Provider Demographics
NPI:1588103725
Name:PATRICK KWAN MD, INC.
Entity type:Organization
Organization Name:PATRICK KWAN MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - MD
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:H
Authorized Official - Last Name:KWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-321-3918
Mailing Address - Street 1:3242 COBBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-1738
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3242 COBBLESTONE DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-1738
Practice Address - Country:US
Practice Address - Phone:801-432-2642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty