Provider Demographics
NPI:1710954847
Name:QUAN, DANY KIN MOON (DO)
Entity Type:Individual
Prefix:
First Name:DANY
Middle Name:KIN MOON
Last Name:QUAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4919 E HAZEL DR UNIT 1
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-7776
Mailing Address - Country:US
Mailing Address - Phone:024-311-1526
Mailing Address - Fax:024-312-1496
Practice Address - Street 1:3241 E SHEA BLVD STE 441
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3335
Practice Address - Country:US
Practice Address - Phone:602-388-1180
Practice Address - Fax:602-431-2149
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A9422207P00000X, 207PT0002X
AZ44472083A0300X, 207PT0002X, 207PT0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PT0002XAllopathic & Osteopathic PhysiciansEmergency MedicineMedical ToxicologyGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILI22556Medicare UPIN