Provider Demographics
NPI:1245383264
Name:HA, QUYEN THANH (MD)
Entity Type:Individual
Prefix:DR
First Name:QUYEN
Middle Name:THANH
Last Name:HA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12883
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73157-2883
Mailing Address - Country:US
Mailing Address - Phone:405-858-0600
Mailing Address - Fax:405-858-0602
Practice Address - Street 1:430 N MONTE VISTA ST
Practice Address - Street 2:VALLEY VIEW REG HOSPITAL WOUND CARE CENTER
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4610
Practice Address - Country:US
Practice Address - Phone:580-272-1731
Practice Address - Fax:580-272-1720
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24063207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200108140AMedicaid
OK200108140AMedicaid