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General NPI Number Information
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NPI Number | 1194784058
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Entity Type | Individual
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Provider Name | LONG THANG QUAN M.D., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/20/2006
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Last Update Date | 10/09/2007
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Provider Practice Location Address
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Address Line | 1706 SAINT JULIAN PL
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City | COLUMBIA
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State | SC
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Zip | 29204-2410
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Country | US
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Telephone | 803-771-7506
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Fax | 803-771-9455
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Provider Business Mailing Address
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Address Line | 1706 SAINT JULIAN PL
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City | COLUMBIA
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State | SC
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Zip | 29204-2410
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Country | US
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Telephone | 803-771-7506
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Fax | 803-771-9455
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 22472
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License Number State | SC
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