Healthcare Provider Details

I. General information

NPI: 1801228275
Provider Name (Legal Business Name): QUAN HADUONG, MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 PROFESSIONAL CT STE 110
LAS VEGAS NV
89128-0837
US

IV. Provider business mailing address

1 AWBREY CT
HENDERSON NV
89052-6707
US

V. Phone/Fax

Practice location:
  • Phone: 702-474-1168
  • Fax:
Mailing address:
  • Phone: 702-469-3938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number7683
License Number StateNV

VIII. Authorized Official

Name: QUAN HADUONG
Title or Position: OWNER
Credential: M.D.
Phone: 702-469-3938