Provider Demographics
NPI:1205063658
Name:QUYEN HA MD PC
Entity type:Organization
Organization Name:QUYEN HA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:QUYEN
Authorized Official - Middle Name:THANH
Authorized Official - Last Name:HA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-799-9068
Mailing Address - Street 1:PO BOX 12883
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73157-2883
Mailing Address - Country:US
Mailing Address - Phone:405-858-0600
Mailing Address - Fax:405-858-0602
Practice Address - Street 1:430 N MONTE VISTA ST
Practice Address - Street 2:VALLEY VIEW REG HOSPITAL WOUND CARE CENTER
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4610
Practice Address - Country:US
Practice Address - Phone:580-272-1731
Practice Address - Fax:580-272-1720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-12
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24063207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200247790AMedicaid
OKOKB5629Medicare PIN