Healthcare Provider Details

I. General information

NPI: 1710326905
Provider Name (Legal Business Name): HUONG TRAN QUY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9559 BOLSA AVE SUITE D
WESTMINSTER CA
92683-5986
US

IV. Provider business mailing address

9559 BOLSA AVE SUITE D
WESTMINSTER CA
92683-5986
US

V. Phone/Fax

Practice location:
  • Phone: 714-531-5754
  • Fax: 714-531-5824
Mailing address:
  • Phone: 714-531-5754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A11084
License Number StateCA

VIII. Authorized Official

Name: DR. HUONG TRAN QUY
Title or Position: PRESIDENT
Credential: D.O.
Phone: 714-531-5754