MEDICARE: STEPHEN QUAN

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
1	183500000X	Pharmacist	40273	CA

General Provider Information

NPI Number	:	1396117743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN QUAN

Provider Business Mailing Address
First Line	:	6265 E 2ND ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-4613
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6265 E 2ND ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-4613
Country	:	US
Telephone Number	:	562-430-6481
Fax Number	:	562-430-6720

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2015
Last Update Date	:	10/26/2015

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Directions to “ STEPHEN QUAN ” Practice Location

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