Basic Information
| Provider Information | |||||||||
| NPI: | 1508154543 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KWAN | ||||||||
| FirstName: | SIMEON | ||||||||
| MiddleName: | MINGTACK | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 COMMERCE ST STE 700 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372011835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154549850 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2425 WEST LOOP S STE 200 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8327864970 | ||||||||
| FaxNumber: | 8557220157 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2011 | ||||||||
| LastUpdateDate: | 08/17/2018 | ||||||||
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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 | 207QH0002X | 307102 | LA | N | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine | 207Q00000X | P4880 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 348533602 | 05 | TX | MEDICAID |