Healthcare Provider Details

I. General information

NPI: 1679721799
Provider Name (Legal Business Name): QUOCDAI DOCHULL PARK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11555 UNIVERSITY BLVD
SUGAR LAND TX
77478-3889
US

IV. Provider business mailing address

11511 SHADOW CREEK PKWY CREDENTIALING SERVICES
PEARLAND TX
77584-7298
US

V. Phone/Fax

Practice location:
  • Phone: 713-442-9100
  • Fax:
Mailing address:
  • Phone: 713-442-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberM8905
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberM8905
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: