Provider Demographics
NPI:1215230503
Name:QUACH, TUNG T (PA-C)
Entity Type:Individual
Prefix:
First Name:TUNG
Middle Name:T
Last Name:QUACH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 SULLIVAN AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2204
Mailing Address - Country:US
Mailing Address - Phone:650-756-5630
Mailing Address - Fax:650-756-0136
Practice Address - Street 1:1850 SULLIVAN AVE STE 330
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2204
Practice Address - Country:US
Practice Address - Phone:650-756-5630
Practice Address - Fax:650-756-0136
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21335363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant