MEDICARE: KAZUO QUAN OMI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	A168135	CA

General Provider Information

NPI Number	:	1356721120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAZUO QUAN OMI MD

Provider Business Mailing Address
First Line	:	284 DUPONT ST STE 130
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92879-6029
Country	:	US
Telephone Number	:	909-206-4057
Fax Number	:	951-518-9145

Provider Business Practice Location Address
First Line	:	284 DUPONT ST STE 130
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92879-6029
Country	:	US
Telephone Number	:	909-206-4057
Fax Number	:	951-518-9145

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2015
Last Update Date	:	06/16/2026

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