MEDICARE: KY VIET DONG QUACH DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	V1589	TX

General Provider Information

NPI Number	:	1114487360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KY VIET DONG QUACH DO

Provider Business Mailing Address
First Line	:	PO BOX 11538
Second Line	:
City	:	KILLEEN
State	:	TX
Zip	:	76547-1538
Country	:	US
Telephone Number	:	254-245-9178
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 WOODHEW DR STE 220205
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76712-6689
Country	:	US
Telephone Number	:	254-245-9175
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2019
Last Update Date	:	01/20/2025

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Directions to “ KY VIET DONG QUACH DO” Practice Location

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