Provider Demographics
NPI:1154713071
Name:QUACH, TAM (DO)
Entity type:Individual
Prefix:
First Name:TAM
Middle Name:
Last Name:QUACH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S CARR RD STE 100
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5802
Mailing Address - Country:US
Mailing Address - Phone:425-227-3700
Mailing Address - Fax:425-227-3116
Practice Address - Street 1:601 S CARR RD STE 100
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5802
Practice Address - Country:US
Practice Address - Phone:425-227-3700
Practice Address - Fax:425-227-3116
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP61126242208100000X
OR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation