Healthcare Provider Details

I. General information

NPI: 1568874675
Provider Name (Legal Business Name): QUAN NHU M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10666 N TORREY PINES RD
LA JOLLA CA
92037-1027
US

IV. Provider business mailing address

10666 N TORREY PINES RD
LA JOLLA CA
92037-1027
US

V. Phone/Fax

Practice location:
  • Phone: 858-554-3200
  • Fax: 858-554-3232
Mailing address:
  • Phone: 858-554-3200
  • Fax: 858-554-3232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA145860
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: