Provider Demographics
NPI:1427363902
Name:QUON, RAYMOND CHOCK (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:CHOCK
Last Name:QUON
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 1:920 N HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1757
Mailing Address - Country:US
Mailing Address - Phone:614-293-2614
Mailing Address - Fax:614-293-7001
Practice Address - Street 1:920 N HAMILTON RD
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-1757
Practice Address - Country:US
Practice Address - Phone:614-293-2614
Practice Address - Fax:614-293-7001
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA113558207Q00000X
OH35126077207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0129596Medicaid
OH0129596Medicaid