Provider Demographics
NPI:1841815545
Name:QUACH, KENNY AU (DPM)
Entity type:Individual
Prefix:DR
First Name:KENNY
Middle Name:AU
Last Name:QUACH
Suffix:
Gender:M
Credentials:DPM
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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
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2023-06-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAEL6963213ES0103X
CAE5920213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery