Provider Demographics
NPI:1700243763
Name:QUACH, TRUNG HA (AT)
Entity type:Individual
Prefix:MR
First Name:TRUNG
Middle Name:HA
Last Name:QUACH
Suffix:
Gender:M
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 W POSADA LANE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOUSE
Mailing Address - State:CA
Mailing Address - Zip Code:95391
Mailing Address - Country:US
Mailing Address - Phone:209-817-3735
Mailing Address - Fax:
Practice Address - Street 1:63 W POSADA LN
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOUSE
Practice Address - State:CA
Practice Address - Zip Code:95391-2041
Practice Address - Country:US
Practice Address - Phone:209-817-3735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANBC-22621174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator