Basic Information
| Provider Information | |||||||||
| NPI: | 1104977420 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KWAN | ||||||||
| FirstName: | GENE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 720 HARRISON AVE | ||||||||
| Address2: | DOB 503 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182371 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 732 HARRISON AVE | ||||||||
| Address2: | PRESTON, 3RD FLOOR | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176387490 | ||||||||
| FaxNumber: | 6174148742 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2007 | ||||||||
| LastUpdateDate: | 06/06/2014 | ||||||||
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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 | 207RC0000X | 238206 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207R00000X | 238206 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.