Basic Information
Provider Information
NPI: 1831506302
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KWAN
FirstName: ISABEL
MiddleName: PUI-YEE
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 501 N GRAHAM STREET
Address2: SUITE 265
City: PORTLAND
State: OR
PostalCode: 97227
CountryCode: US
TelephoneNumber: 8032827002
FaxNumber: 5032801290
Practice Location
Address1: 501 N GRAHAM STREET
Address2: SUITE 265
City: PORTLAND
State: OR
PostalCode: 97227
CountryCode: US
TelephoneNumber: 8032827002
FaxNumber: 5032801290
Other Information
ProviderEnumerationDate: 07/16/2014
LastUpdateDate: 04/22/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/22/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000XMD197434ORN Allopathic & Osteopathic PhysiciansPediatrics 
208000000XMD61029063WAN Allopathic & Osteopathic PhysiciansPediatrics 
208000000X036142730ILN Allopathic & Osteopathic PhysiciansPediatrics 
2080N0001XMD61029063WAN Allopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
2080N0001XMD197434ORY Allopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine

No ID Information.


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