Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A130657 | CA |
N | 111NI0900X | Internist | A130657 | CA |
Y | 207RA0401X | Internist - Addiction Medicine | A130657 | CA |
NPI | 1811253909 |
---|---|
Provider Name | Jonathan Quach |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Santa Monica, CA 90404-3414 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2012 |
Last Update Date | 01/11/2021 |