Healthcare Provider Details

I. General information

NPI: 1639263023
Provider Name (Legal Business Name): HUNG QUAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9191 WESTMINSTER AVE
GARDEN GROVE CA
92844-2751
US

IV. Provider business mailing address

9191 WESTMINSTER AVE
GARDEN GROVE CA
92844-2751
US

V. Phone/Fax

Practice location:
  • Phone: 714-899-2000
  • Fax:
Mailing address:
  • Phone: 714-899-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number95326
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA53594
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: