Provider Demographics
NPI:1235611666
Name:QUANTUM INTERVENTIONAL SPORTS AND SPINE MEDICINE
Entity Type:Organization
Organization Name:QUANTUM INTERVENTIONAL SPORTS AND SPINE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRUNG
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:HA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:694-913-6136
Mailing Address - Street 1:1451 W AIRPORT FWY STE 1
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-6223
Mailing Address - Country:US
Mailing Address - Phone:469-913-6136
Mailing Address - Fax:877-559-7679
Practice Address - Street 1:1451 W AIRPORT FWY STE 1
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-6223
Practice Address - Country:US
Practice Address - Phone:469-913-6136
Practice Address - Fax:877-559-7679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-01
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ3883208VP0014X
208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty