Basic Information
| Provider Information | |||||||||
| NPI: | 1205097474 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KWAN | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 UCLA MEDICAL PLZ STE 255 | ||||||||
| Address2: | UCLA DEPT OF ORTHOPAEDIC SURGERY / HAND & MICROSURGERY | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900246913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108256557 | ||||||||
| FaxNumber: | 3108251311 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 UCLA MEDICAL PLZ STE 255 | ||||||||
| Address2: | UCLA DEPT OF ORTHOPAEDIC SURGERY / HAND & MICROSURGERY | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900246913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108256557 | ||||||||
| FaxNumber: | 3108251311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2008 | ||||||||
| LastUpdateDate: | 12/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | A104349 | CA | N | Allopathic & Osteopathic Physicians | Surgery | 208200000X | A104349 | CA | Y | Allopathic & Osteopathic Physicians | Plastic Surgery |
No ID Information.