Provider Demographics
NPI:1093177016
Name:QUACH, LIAN (DO)
Entity Type:Individual
Prefix:DR
First Name:LIAN
Middle Name:
Last Name:QUACH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 MEDICAL CENTER DRIVE EAST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611
Mailing Address - Country:US
Mailing Address - Phone:559-256-4111
Mailing Address - Fax:
Practice Address - Street 1:155 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-2302
Practice Address - Country:US
Practice Address - Phone:599-499-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A15861208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program