Provider Demographics
NPI:1851385488
Name:QUACH, TIN HUAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:TIN
Middle Name:HUAN
Last Name:QUACH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4103 N JACKSON RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-6612
Mailing Address - Country:US
Mailing Address - Phone:956-682-4187
Mailing Address - Fax:956-682-9739
Practice Address - Street 1:4103 N JACKSON RD STE 200
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6612
Practice Address - Country:US
Practice Address - Phone:956-682-4187
Practice Address - Fax:956-682-9739
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1742213EP1101X, 213ES0000X, 213ES0131X, 213E00000X
LAPD0144213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174195101Medicaid
TX611819Medicare PIN
TX5479520001Medicare NSC
TX174195101Medicaid