Provider Demographics
NPI:1609802032
Name:QUON, MICHAEL GIN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GIN
Last Name:QUON
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 1:23928 LYONS AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2409
Mailing Address - Country:US
Mailing Address - Phone:661-799-0615
Mailing Address - Fax:661-254-3185
Practice Address - Street 1:23928 LYONS AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2409
Practice Address - Country:US
Practice Address - Phone:661-799-0615
Practice Address - Fax:661-254-3185
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63134207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9653125Medicaid
CA9653125Medicaid