Provider Demographics
NPI:1831133511
Name:QUAN, THANH-LAN TRONG (MD)
Entity Type:Individual
Prefix:
First Name:THANH-LAN
Middle Name:TRONG
Last Name:QUAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10362 BOLSA AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683
Mailing Address - Country:US
Mailing Address - Phone:714-531-4804
Mailing Address - Fax:714-531-8232
Practice Address - Street 1:10362 BOLSA AVE
Practice Address - Street 2:STE 201
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683
Practice Address - Country:US
Practice Address - Phone:714-531-4804
Practice Address - Fax:714-531-8232
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69821207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G698211Medicaid
CAG69821AMedicare ID - Type Unspecified
F57064Medicare UPIN
CA00G698211Medicaid