NPIMap

Individual provider Active NPI

Lan Ngoc Quang, M.D.

  • Internal Medicine Physician
  • Stockton, CA
National Provider Identifier
1437354347
Registry record updated Feb 2, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A111373 Issued in CA
Practice address
1525 N El Dorado St
Suite 1
Stockton, CA 95204-5932
Phone
(209) 465-5107
NPI assigned
Jun 19, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MT191351 PA
Internal Medicine Physician 207R00000X A111373 CA Primary

Addresses

Primary practice location

1525 N El Dorado St
Suite 1
Stockton, CA 95204-5932

Mailing address

1525 N El Dorado St
Suite 1
Stockton, CA 95204-5932
Phone (209) 465-5107

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120802000656 CA Practitioner - Nephrology 6002062288 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Hahnemann University College of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1525 N El Dorado St
Suite 1
Stockton, CA 95204-5932
Phone (209) 465-5107

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Stockton Nephrology, Inc. CurrentSince Apr 8, 2014 Accepting new patients
Sequoia Health Services Past Accepting new patients
George R Herron Jr MD Inc Internal Medicine PastSince Nov 4, 2008 Accepting new patients
Port City Operating Company, LLC Past Accepting new patients

Locations

1525 N El Dorado St
Ste 1
Stockton, CA 95204
Phone (209) 452-8368

1610 N El Dorado St
Ste 17
Stockton, CA 95204
Phone (209) 465-5107

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485993600000",
    "number": "1437354347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1525 N EL DORADO ST",
            "address_2": "SUITE 1",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952045932",
            "telephone_number": "209-465-5107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 N EL DORADO ST",
            "address_2": "SUITE 1",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952045932",
            "telephone_number": "209-465-5107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUANG",
        "first_name": "LAN",
        "middle_name": "NGOC",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-19",
        "last_updated": "2017-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MT191351",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A111373",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

Sources for this page

Verify at the official NPI Registry.