Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 12160 | SD |
NPI | 1013370352 |
---|---|
Provider Name | Wynn-C Kwan |
First Address | Aberdeen, SD 57401-5420 |
Second Address | New Orleans, LA 70112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2016 |
Last Update Date | 05/01/2021 |