Individual provider Active NPI

Matthew David Kwan, M.D.

  • Plastic Surgery Physician
  • Los Angeles, CA
National Provider Identifier
1205097474
Registry record updated Dec 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
A104349 Issued in CA
Practice address
100 UCLA Medical PLZ Ste 255
UCLA Dept of Orthopaedic Surgery / Hand & Microsurgery
Los Angeles, CA 90024-6913
Phone
(310) 825-6557
Fax
(310) 825-1311
NPI assigned
Jun 20, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X A104349 CA
Plastic Surgery Physician 208200000X A104349 CA Primary

Addresses

Primary practice location

100 UCLA Medical PLZ Ste 255
UCLA Dept of Orthopaedic Surgery / Hand & Microsurgery
Los Angeles, CA 90024-6913

Mailing address

100 UCLA Medical PLZ Ste 255
UCLA Dept of Orthopaedic Surgery / Hand & Microsurgery
Los Angeles, CA 90024-6913
Phone (310) 825-6557

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq Health Information Exchange (HIE) The Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120730000397 CA Practitioner - Plastic and Reconstructive SurgeryPractitioner - Hand Surgery 2860658200 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive SurgeryAlso: Hand Surgery
Education
University of Maryland School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Permanente Medical Group IncGroup PAC ID 8921910225, 10,928 clinicians

Practice addresses (Care Compare)

700 Lawrence Expy
Santa Clara, CA 95051-5173
Phone (408) 851-1000

710 Lawrence Express Way
Santa Clara, CA 95051-5173
Phone (408) 851-1000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A104349CAMDPlastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Permanente Medical Group Inc Surgery CurrentSince Oct 8, 2013 Accepting new patients
Permanente Medical Group, Inc CurrentSince Oct 8, 2013 Accepting new patients
Permanente Medical Group Inc Surgery Current Accepting new patients

Locations

1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015

901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500

2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000

700 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 851-5300

710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400

7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000

975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639958400000",
    "number": "1205097474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 UCLA MEDICAL PLZ STE 255",
            "address_2": "UCLA DEPT OF ORTHOPAEDIC SURGERY / HAND & MICROSURGERY",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900246913",
            "telephone_number": "310-825-6557",
            "fax_number": "310-825-1311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 UCLA MEDICAL PLZ STE 255",
            "address_2": "UCLA DEPT OF ORTHOPAEDIC SURGERY / HAND & MICROSURGERY",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900246913",
            "telephone_number": "310-825-6557",
            "fax_number": "310-825-1311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWAN",
        "first_name": "MATTHEW",
        "middle_name": "DAVID",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-20",
        "last_updated": "2021-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A104349",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "CA",
            "license": "A104349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "700 Lawrence Expy",
            "city": "Santa Clara",
            "state": "CA",
            "country_code": "US",
            "postal_code": "950515173",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.