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NPI Code Detail

MEDICARE: VI Q QUAN DMD PC

MEDICARE: VI Q QUAN DMD PC
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
11223G0001XGeneral Practice Dentistry019-026196IL

General Provider Information

NPI Number : 1831411990
Entity Type Code : Organization
Provider Name (Legal Business Name) : VI Q QUAN DMD PC
Provider Business Mailing Address
First Line : 7723 W CLARENCE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60631-1833
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 : PRESIDENT
Name : DR. VI QUAN QUAN
Credential : D.M.D.
Telephone Number : 773-405-4220
Provider Enumeration Date : 02/17/2010
Last Update Date : 02/17/2010

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Directions to “VI Q QUAN DMD PC ” Practice Location

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