Provider Demographics
NPI:1114364361
Name:QUACH, GIAO (MD)
Entity Type:Individual
Prefix:
First Name:GIAO
Middle Name:
Last Name:QUACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3137 W INDIAN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85017-4069
Mailing Address - Country:US
Mailing Address - Phone:520-248-8630
Mailing Address - Fax:
Practice Address - Street 1:6611 W PEORIA AVE
Practice Address - Street 2:SUITE 13
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-7000
Practice Address - Country:US
Practice Address - Phone:602-325-5580
Practice Address - Fax:602-926-1382
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU8573207Q00000X
AZ52780207Q00000X
WAMD61432846207Q00000X
CODR.0070875207Q00000X
GA99028207Q00000X
MA1017300207Q00000X
NC2023-02903207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine