Provider Demographics
NPI:1093990301
Name:QUACH, LE MINH (BS/RDH)
Entity Type:Individual
Prefix:MR
First Name:LE
Middle Name:MINH
Last Name:QUACH
Suffix:
Gender:M
Credentials:BS/RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2664 BERRYESSA RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-2925
Mailing Address - Country:US
Mailing Address - Phone:408-431-6975
Mailing Address - Fax:408-258-8838
Practice Address - Street 1:2664 BERRYESSA RD
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95132-2925
Practice Address - Country:US
Practice Address - Phone:408-431-6975
Practice Address - Fax:408-258-8838
Is Sole Proprietor?:No
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22109124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist