Healthcare Provider Details

I. General information

NPI: 1952691123
Provider Name (Legal Business Name): QUINN MONG DANG R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 W BROAD ST
FALLS CHURCH VA
22046-4610
US

IV. Provider business mailing address

9959 E HILL DR
LORTON VA
22079-2431
US

V. Phone/Fax

Practice location:
  • Phone: 703-241-5031
  • Fax: 703-241-5037
Mailing address:
  • Phone: 214-923-3061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number0202209627
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202209627
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: