Healthcare Provider Details

I. General information

NPI: 1154926160
Provider Name (Legal Business Name): QUAN KY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 EUBANK BLVD NE STE 110
ALBUQUERQUE NM
87111-1519
US

IV. Provider business mailing address

5600 EUBANK BLVD NE STE 110
ALBUQUERQUE NM
87111-1519
US

V. Phone/Fax

Practice location:
  • Phone: 505-880-1920
  • Fax:
Mailing address:
  • Phone: 505-880-1920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2025-0157
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: