Provider Demographics
NPI:1144318882
Name:QUACH, LIEN KIM
Entity type:Individual
Prefix:MS
First Name:LIEN
Middle Name:KIM
Last Name:QUACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 HASTI ACRES DR
Mailing Address - Street 2:#9
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309
Mailing Address - Country:US
Mailing Address - Phone:661-396-1169
Mailing Address - Fax:661-397-6188
Practice Address - Street 1:1801 HASTI ACRES DR
Practice Address - Street 2:#9
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309
Practice Address - Country:US
Practice Address - Phone:661-396-1169
Practice Address - Fax:661-397-6188
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA445301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4453001Medicare ID - Type Unspecified