Provider Demographics
NPI:1033220256
Name:QUAN, HAROLD E
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:E
Last Name:QUAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:HAROLD
Other - Middle Name:E
Other - Last Name:QUAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:23928 LYONS AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2409
Mailing Address - Country:US
Mailing Address - Phone:661-255-8321
Mailing Address - Fax:661-255-0338
Practice Address - Street 1:23928 LYONS AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2409
Practice Address - Country:US
Practice Address - Phone:661-255-8321
Practice Address - Fax:661-255-0338
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34182207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A341820Medicaid
P00627080OtherRR MEDICARE
CAA34182OtherCALIFORNIA STATE LICENSE
BU573ZMedicare PIN
CA00A341820Medicaid