Provider Demographics
NPI:1215960943
Name:QUACH, QUANG CHI (DO)
Entity type:Individual
Prefix:
First Name:QUANG
Middle Name:CHI
Last Name:QUACH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9251 BOLSA AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5534
Mailing Address - Country:US
Mailing Address - Phone:714-248-9841
Mailing Address - Fax:714-248-9843
Practice Address - Street 1:9251 BOLSA AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5534
Practice Address - Country:US
Practice Address - Phone:714-248-9841
Practice Address - Fax:714-248-9843
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6918207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A6918OtherSTATE MEDICAL LICENSE
CAW20A6918AMedicare ID - Type UnspecifiedMEDICARE PPIN
CA20A6918OtherSTATE MEDICAL LICENSE