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NPI Code Detail

MEDICARE: VI QUAN QUAN D.M.D.

MEDICARE: VI QUAN QUAN D.M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistDN012782GA
2122300000XDentistIL

General Provider Information

NPI Number : 1114068350
Entity Type Code : Individual
Provider Name (Legal Business Name) : VI QUAN QUAN D.M.D.
Provider Business Mailing Address
First Line : 2210 W. WABANSIA AVE,
Second Line : UNIT 404
City : CHICAGO
State : IL
Zip : 60647-5488
Country : US
Telephone Number : 773-405-4220
Fax Number :
Provider Business Practice Location Address
First Line : 3939 W FULLERTON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-2243
Country : US
Telephone Number : 773-235-0000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2007
Last Update Date : 07/08/2007

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Directions to “ VI QUAN QUAN D.M.D.” Practice Location

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