Provider Demographics
NPI:1497760987
Name:VIET D. TA, MD & TIFFANY L. QUAN, MD MEDICAL ASSOCIATES INC.
Entity Type:Organization
Organization Name:VIET D. TA, MD & TIFFANY L. QUAN, MD MEDICAL ASSOCIATES INC.
Other - Org Name:FOOTHILL PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIET
Authorized Official - Middle Name:DUY
Authorized Official - Last Name:TA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-484-4900
Mailing Address - Street 1:8235 ROCHESTER AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-0719
Mailing Address - Country:US
Mailing Address - Phone:909-484-4900
Mailing Address - Fax:909-243-7868
Practice Address - Street 1:8235 ROCHESTER AVE STE 110
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0719
Practice Address - Country:US
Practice Address - Phone:909-484-4900
Practice Address - Fax:909-243-7868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69957207Q00000X
CAA77358208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0096040Medicaid
CAGR0096040Medicaid