Healthcare Provider Details

I. General information

NPI: 1659580751
Provider Name (Legal Business Name): ALBERT H. QUAN, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 FOREST LN SUITE A311
DALLAS TX
75230-2505
US

IV. Provider business mailing address

7777 FOREST LN SUITE A311
DALLAS TX
75230-2505
US

V. Phone/Fax

Practice location:
  • Phone: 972-566-7885
  • Fax: 972-566-3919
Mailing address:
  • Phone: 972-566-7885
  • Fax: 972-566-3919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALBERT H. QUAN
Title or Position: PRESIDENT
Credential: MD
Phone: 972-566-7885