Provider Demographics
NPI:1194325316
Name:QUACH, ANHDAO NGOC (LAC, DOM)
Entity type:Individual
Prefix:
First Name:ANHDAO
Middle Name:NGOC
Last Name:QUACH
Suffix:
Gender:F
Credentials:LAC, DOM
Other - Prefix:
Other - First Name:THERRESA
Other - Middle Name:ANHDAO NGOC
Other - Last Name:QUACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC, OMD
Mailing Address - Street 1:18682 BEACH BLVD STE 165
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-2076
Mailing Address - Country:US
Mailing Address - Phone:714-465-9599
Mailing Address - Fax:
Practice Address - Street 1:18682 BEACH BLVD STE 165
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2076
Practice Address - Country:US
Practice Address - Phone:714-465-9599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC62612251X0800X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic