Organization
SAN WAN, MDPC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAN WAN M.D. (PRESIDENT)
(781) 647-9863
Entity
Organization
Contact information
Practice address
340 WOOD RD, BRAINTREE, MA 02184-2401
(781) 849-1111
Mailing address
8 WILDFLOWER LN, WESTON, MA 02493-1167
(781) 647-9863
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9737812
—
MA
01
—
M13923
BLUE CROSS BLUE SHIELD
MA
Enumeration date
02/10/2006
Last updated
08/22/2020
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