Provider Demographics
NPI:1134502172
Name:QUACH, KIM (NP)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:QUACH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 SCOTT ST FL 8
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14204-2208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:199 SCOTT ST FL 8
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14204-2208
Practice Address - Country:US
Practice Address - Phone:917-261-4414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-08
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA850720163W00000X
NY657159163W00000X
NJ26NR18225600163W00000X
MARN2377450163W00000X, 363LF0000X
IL041555192163W00000X
CT203362163W00000X
NJ26NJ00639900363LF0000X
CA95025238363LF0000X
IL209030518363LF0000X
CT11592363LF0000X
NYF340606-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse