Provider Demographics
NPI:1831411990
Name:VI Q QUAN DMD PC
Entity type:Organization
Organization Name:VI Q QUAN DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VI
Authorized Official - Middle Name:QUAN
Authorized Official - Last Name:QUAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:773-405-4220
Mailing Address - Street 1:7723 W CLARENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-1833
Mailing Address - Country:US
Mailing Address - Phone:773-405-4220
Mailing Address - Fax:
Practice Address - Street 1:3939 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2243
Practice Address - Country:US
Practice Address - Phone:773-235-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0261961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty