MEDICARE: JONATHON QUANG

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	208100000X	Physical Medicine & Rehabilitation Physician	305287	CA

General Provider Information

NPI Number	:	1750158598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHON QUANG

Provider Business Mailing Address
First Line	:	10720 MATINAL CIR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92127-1255
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5807 UNIVERSITY AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-6295
Country	:	US
Telephone Number	:	619-500-1098
Fax Number	:

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

Provider Enumeration Date	:	12/11/2023
Last Update Date	:	12/11/2023

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Directions to “ JONATHON QUANG ” Practice Location

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