1629051917 NPI number — DR. KATHERINE KAR-HWEE QUAN M.D.

Table of content: DR. KATHERINE KAR-HWEE QUAN M.D. (NPI 1629051917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629051917 NPI number — DR. KATHERINE KAR-HWEE QUAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUAN
Provider First Name:
KATHERINE
Provider Middle Name:
KAR-HWEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LIM
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
KAR-HWEE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1629051917
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 S DOBSON RD STE 223
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHANDLER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85286-6160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-821-8888
Provider Business Mailing Address Fax Number:
480-821-0888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 S DOBSON RD STE 223
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHANDLER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85286-6160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-821-8888
Provider Business Practice Location Address Fax Number:
480-821-0888
Provider Enumeration Date:
11/21/2005

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: 207ND0101X , with the licence number:  25345 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207N00000X , with the licence number: 25345 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 385551 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 070011301 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 86080015085259A375 . This is a "TRIWEST" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 41-2054293 . This is a "TAX-ID" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".