Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | J3880 | TX |
NPI | 1689615114 |
---|---|
Provider Name | Albert H Quan |
First Address | Dallas, TX 75230-2505 |
Second Address | Dallas, TX 75230-2505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 26/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F58569 | (02) |