Healthcare Provider Details

I. General information

NPI: 1356721120
Provider Name (Legal Business Name): KAZUO QUAN OMI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 DUPONT ST STE 130
CORONA CA
92879-6029
US

IV. Provider business mailing address

284 DUPONT ST STE 130
CORONA CA
92879-6029
US

V. Phone/Fax

Practice location:
  • Phone: 909-206-4057
  • Fax: 951-518-9145
Mailing address:
  • Phone: 909-206-4057
  • Fax: 951-518-9145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA168135
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: