Provider Demographics
NPI:1881829851
Name:QUAN, FENG (HEARING AID DISPENSE)
Entity Type:Individual
Prefix:MR
First Name:FENG
Middle Name:
Last Name:QUAN
Suffix:
Gender:M
Credentials:HEARING AID DISPENSE
Other - Prefix:MR
Other - First Name:JIMMY
Other - Middle Name:
Other - Last Name:QUAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HEARING AID DISPENSE
Mailing Address - Street 1:27001 LA PAZ RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5502
Mailing Address - Country:US
Mailing Address - Phone:949-770-4327
Mailing Address - Fax:949-770-4329
Practice Address - Street 1:27001 LA PAZ RD
Practice Address - Street 2:SUITE 290
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5502
Practice Address - Country:US
Practice Address - Phone:949-770-4327
Practice Address - Fax:949-770-4329
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA7263237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist