Healthcare Provider Details

I. General information

NPI: 1922207463
Provider Name (Legal Business Name): TQ PEDIATRICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2007
Last Update Date: 05/06/2022
Certification Date: 05/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10900 WARNER AVE SUITE 118
FOUNTAIN VALLEY CA
92708-3846
US

IV. Provider business mailing address

PO BOX 11704
WESTMINSTER CA
92685-1704
US

V. Phone/Fax

Practice location:
  • Phone: 714-968-7938
  • Fax: 714-968-7990
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA92305
License Number StateCA

VIII. Authorized Official

Name: THANH QUOC NGUYEN
Title or Position: C.E.O.
Credential:
Phone: 714-968-7938