Provider Demographics
NPI:1376980193
Name:QUANG, KEVIN T (DPM)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:T
Last Name:QUANG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W. ELGIN ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012
Mailing Address - Country:US
Mailing Address - Phone:918-455-2001
Mailing Address - Fax:918-301-0088
Practice Address - Street 1:5711 E 71ST ST STE 115
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6655
Practice Address - Country:US
Practice Address - Phone:918-494-2955
Practice Address - Fax:918-494-2905
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK319213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist