Provider Demographics
NPI:1215950118
Name:QUON, BRENDA SAU KIT (MD)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:SAU KIT
Last Name:QUON
Suffix:
Gender:F
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:PO BOX 743
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91021-0743
Mailing Address - Country:US
Mailing Address - Phone:626-616-2226
Mailing Address - Fax:
Practice Address - Street 1:601 S FIGUEROA ST
Practice Address - Street 2:SUITE 4025
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-5704
Practice Address - Country:US
Practice Address - Phone:626-616-2226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA610732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A610730Medicaid
CA00A610730OtherBLUE SHIELD
CA137422OtherVALUE OPTIONS
CAW13030Medicare ID - Type Unspecified