Provider Demographics
NPI:1033123146
Name:QUACH, THOMAS T (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:T
Last Name:QUACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9186 BOLSA AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5556
Mailing Address - Country:US
Mailing Address - Phone:714-799-7522
Mailing Address - Fax:714-799-7523
Practice Address - Street 1:9186 BOLSA AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5556
Practice Address - Country:US
Practice Address - Phone:714-799-7522
Practice Address - Fax:714-799-7523
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG080556207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G805560Medicaid
CA00G805560Medicaid
CAG50495Medicare UPIN