1497760987 NPI number — VIET D. TA, MD & TIFFANY L. QUAN, MD MEDICAL ASSOCIATES INC.

Table of content: (NPI 1497760987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497760987 NPI number — VIET D. TA, MD & TIFFANY L. QUAN, MD MEDICAL ASSOCIATES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIET D. TA, MD & TIFFANY L. QUAN, MD MEDICAL ASSOCIATES INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497760987
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8235 ROCHESTER AVE STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANCHO CUCAMONGA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91730-0719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-484-4900
Provider Business Mailing Address Fax Number:
909-243-7868

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8235 ROCHESTER AVE STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RANCHO CUCAMONGA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91730-0719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-484-4900
Provider Business Practice Location Address Fax Number:
909-243-7868
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TA
Authorized Official First Name:
VIET
Authorized Official Middle Name:
DUY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
909-484-4900

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  A77358 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: A69957 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GR0096040 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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