Healthcare Provider Details

I. General information

NPI: 1255360780
Provider Name (Legal Business Name): WINCHELL WING QUOCK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 8TH AVE SUITE 202
SAN FRANCISCO CA
94118
US

IV. Provider business mailing address

402 8TH AVE SUITE 202
SAN FRANCISCO CA
94118
US

V. Phone/Fax

Practice location:
  • Phone: 415-751-1411
  • Fax: 415-751-3923
Mailing address:
  • Phone: 415-751-1411
  • Fax: 415-751-3923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG28410
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: