MEDICARE: ILIN QUAN

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1962283853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILIN QUAN

Provider Business Mailing Address
First Line	:	7906 4TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-3907
Country	:	US
Telephone Number	:	718-704-0898
Fax Number	:	718-540-8840

Provider Business Practice Location Address
First Line	:	7906 4TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-3907
Country	:	US
Telephone Number	:	718-704-0898
Fax Number	:	718-540-8840

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

Provider Enumeration Date	:	10/09/2023
Last Update Date	:	10/09/2023

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Directions to “ ILIN QUAN ” Practice Location

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