Provider Demographics
NPI:1902150725
Name:KWAN, CALVIN (NMD)
Entity Type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:
Last Name:KWAN
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8012 15TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-3601
Mailing Address - Country:US
Mailing Address - Phone:425-686-9369
Mailing Address - Fax:
Practice Address - Street 1:2152 E BROADWAY RD # 200
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1751
Practice Address - Country:US
Practice Address - Phone:480-970-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19-1769175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath