Provider Demographics
NPI:1588213458
Name:QUANTUMV MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:QUANTUMV MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:KATSUMI
Authorized Official - Last Name:SUGIMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH, FAAFP
Authorized Official - Phone:650-294-8451
Mailing Address - Street 1:46 SHATTUCK SQ STE 16
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1154
Mailing Address - Country:US
Mailing Address - Phone:650-294-8451
Mailing Address - Fax:
Practice Address - Street 1:46 SHATTUCK SQ STE 16
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1154
Practice Address - Country:US
Practice Address - Phone:650-294-8451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty