Healthcare Provider Details

I. General information

NPI: 1710954847
Provider Name (Legal Business Name): DANY KIN MOON QUAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3241 E SHEA BLVD STE 441
PHOENIX AZ
85028-3335
US

IV. Provider business mailing address

4919 E HAZEL DR UNIT 1
PHOENIX AZ
85044-7776
US

V. Phone/Fax

Practice location:
  • Phone: 602-388-1180
  • Fax: 602-431-2149
Mailing address:
  • Phone: 24-311-1526
  • Fax: 24-312-1496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A9422
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License Number20A9422
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number4447
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License Number4447
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: