Provider Demographics
NPI:1649321761
Name:HAN, HUY QUANG (MD)
Entity type:Individual
Prefix:DR
First Name:HUY
Middle Name:QUANG
Last Name:HAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11028 LOWER AZUSA RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-1440
Mailing Address - Country:US
Mailing Address - Phone:626-455-0048
Mailing Address - Fax:
Practice Address - Street 1:11028 LOWER AZUSA RD
Practice Address - Street 2:SUITE C
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-1440
Practice Address - Country:US
Practice Address - Phone:626-455-0048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA066690207R00000X, 207RN0300X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI08062Medicare UPIN