Provider Demographics
NPI:1518999374
Name:BACH, THUC T (MD)
Entity Type:Individual
Prefix:DR
First Name:THUC
Middle Name:T
Last Name:BACH
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 1:1021 S GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4710
Mailing Address - Country:US
Mailing Address - Phone:626-282-6740
Mailing Address - Fax:626-282-6053
Practice Address - Street 1:1021 S GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4710
Practice Address - Country:US
Practice Address - Phone:626-282-6740
Practice Address - Fax:626-282-6053
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31717174400000X, 208600000X, 246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No174400000XOther Service ProvidersSpecialist
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA31717Medicare ID - Type Unspecified