Healthcare Provider Details

I. General information

NPI: 1003578824
Provider Name (Legal Business Name): LIEN KIM QUACH DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2021
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 BRUNDAGE LN
BAKERSFIELD CA
93304-3114
US

IV. Provider business mailing address

PO BOX 9579
BAKERSFIELD CA
93389-9579
US

V. Phone/Fax

Practice location:
  • Phone: 661-323-0076
  • Fax: 661-323-0277
Mailing address:
  • Phone: 661-323-0076
  • Fax: 661-323-0277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DARU WARDONO
Title or Position: OFFICE MANAGER
Credential:
Phone: 661-323-0076