1881829851 NPI number — MR. FENG QUAN HEARING AID DISPENSE

Table of content: MR. FENG QUAN HEARING AID DISPENSE (NPI 1881829851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881829851 NPI number — MR. FENG QUAN HEARING AID DISPENSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUAN
Provider First Name:
FENG
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
HEARING AID DISPENSE
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
QUAN
Provider Other First Name:
JIMMY
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
HEARING AID DISPENSE
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1881829851
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27001 LA PAZ RD
Provider Second Line Business Mailing Address:
SUITE 290
Provider Business Mailing Address City Name:
MISSION VIEJO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92691-5502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-770-4327
Provider Business Mailing Address Fax Number:
949-770-4329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27001 LA PAZ RD
Provider Second Line Business Practice Location Address:
SUITE 290
Provider Business Practice Location Address City Name:
MISSION VIEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92691-5502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-770-4327
Provider Business Practice Location Address Fax Number:
949-770-4329
Provider Enumeration Date:
05/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 237700000X , with the licence number:  HA7263 , 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)





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