1558768374 NPI number — NGUYEN QUACH OD A PROFESSIONAL CORPORATION

Table of content: (NPI 1558768374)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558768374 NPI number — NGUYEN QUACH OD A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NGUYEN QUACH OD A PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558768374
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1880 PRAIRIE CITY RD
Provider Second Line Business Mailing Address:
STE 130
Provider Business Mailing Address City Name:
FOLSOM
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95630-9593
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-985-7848
Provider Business Mailing Address Fax Number:
888-789-5412

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1880 PRAIRIE CITY RD
Provider Second Line Business Practice Location Address:
STE 130
Provider Business Practice Location Address City Name:
FOLSOM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95630-9593
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-985-7848
Provider Business Practice Location Address Fax Number:
888-789-5412
Provider Enumeration Date:
11/21/2014

Additional Information

Authorized Official

Authorized Official Last Name:
QUACH
Authorized Official First Name:
NGUYEN
Authorized Official Middle Name:
HUNG
Authorized Official Title or Position:
CEO / PRESIDENT
Authorized Official Telephone Number:
530-723-4005

Provider Taxonomy Codes

  • Taxonomy code: 152WS0006X , with the licence number:  13774 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1558768374 . This is a "NGUYEN QUACH OD A PROFESSIONAL CORPORATION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com