Provider Demographics
NPI:1255647251
Name:JUSTIN QUOCK, M.D., INC.
Entity type:Organization
Organization Name:JUSTIN QUOCK, M.D., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:QUOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-398-5100
Mailing Address - Street 1:929 CLAY ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-1556
Mailing Address - Country:US
Mailing Address - Phone:415-398-5100
Mailing Address - Fax:415-837-1408
Practice Address - Street 1:929 CLAY ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-1556
Practice Address - Country:US
Practice Address - Phone:415-398-5100
Practice Address - Fax:415-837-1408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55916261QX0200X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A559160Medicaid
CAA55916Medicare PIN
CA00A559160Medicaid