Provider Demographics
NPI:1194429977
Name:VAN, QUY (DO)
Entity type:Individual
Prefix:
First Name:QUY
Middle Name:
Last Name:VAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9172 TUSCAN VALLEY PL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-7581
Mailing Address - Country:US
Mailing Address - Phone:941-681-6628
Mailing Address - Fax:
Practice Address - Street 1:582 CONCORD RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-2616
Practice Address - Country:US
Practice Address - Phone:470-956-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program