Healthcare Provider Details

I. General information

NPI: 1417152430
Provider Name (Legal Business Name): QUAN T. MA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6635 FLANDERS DR SUITE E
SAN DIEGO CA
92121-2978
US

IV. Provider business mailing address

6650 FLANDERS DR STE J
SAN DIEGO CA
92121-3908
US

V. Phone/Fax

Practice location:
  • Phone: 858-457-4100
  • Fax:
Mailing address:
  • Phone: 215-380-1715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401412328
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number62908
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14099
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: