Provider Demographics
NPI:1154475366
Name:QUAN, HUNG Q (DDS)
Entity Type:Individual
Prefix:
First Name:HUNG
Middle Name:Q
Last Name:QUAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12238 DARKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-3751
Mailing Address - Country:US
Mailing Address - Phone:858-484-4272
Mailing Address - Fax:
Practice Address - Street 1:4748 UNIVERSITY AVE STE D
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1972
Practice Address - Country:US
Practice Address - Phone:619-640-8637
Practice Address - Fax:619-640-8647
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2020-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48171122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist