Provider Demographics
NPI:1689350274
Name:KENNY QUACH DPM
Entity Type:Organization
Organization Name:KENNY QUACH DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:AU
Authorized Official - Last Name:QUACH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:714-979-0313
Mailing Address - Street 1:11100 WARNER AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7512
Mailing Address - Country:US
Mailing Address - Phone:714-979-0313
Mailing Address - Fax:714-979-0340
Practice Address - Street 1:11100 WARNER AVE STE 306
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7512
Practice Address - Country:US
Practice Address - Phone:714-979-0313
Practice Address - Fax:714-979-0340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-27
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty