Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 20A6918 | CA |
NPI | 1215960943 |
---|---|
Provider Name | Quang Chi Quach |
First Address | Westminster, CA 92683-5534 |
Second Address | Westminster, CA 92683-5534 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2006 |
Last Update Date | 28/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20A6918 | STATE MEDICAL LICENSE (01) | CA |
G16350 | (02) | CA |