Individual
WILLIAM KWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8300 CONSTITUTION AVE NE, ALBUQUERQUE, NM 87110
(505) 291-2402
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD2018-0751
NM
390200000X
Student in an Organized Health Care Education/Training Program
ML60574266
WA
Other
Enumeration date
07/01/2015
Last updated
09/14/2018
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