MEDICARE: LAN NGOC QUANG 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
1	207R00000X	Internal Medicine Physician	MT191351	PA
2	207R00000X	Internal Medicine Physician	A111373	CA

General Provider Information

NPI Number	:	1437354347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAN NGOC QUANG M.D.

Provider Business Mailing Address
First Line	:	1525 N EL DORADO ST
Second Line	:	SUITE 1
City	:	STOCKTON
State	:	CA
Zip	:	95204-5932
Country	:	US
Telephone Number	:	209-465-5107
Fax Number	:

Provider Business Practice Location Address
First Line	:	1525 N EL DORADO ST
Second Line	:	SUITE 1
City	:	STOCKTON
State	:	CA
Zip	:	95204-5932
Country	:	US
Telephone Number	:	209-465-5107
Fax Number	:

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

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	02/02/2017

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