Healthcare Provider Details

I. General information

NPI: 1144318882
Provider Name (Legal Business Name): MS. LIEN KIM QUACH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 HASTI ACRES DR #9
BAKERSFIELD CA
93309
US

IV. Provider business mailing address

1801 HASTI ACRES DR #9
BAKERSFIELD CA
93309
US

V. Phone/Fax

Practice location:
  • Phone: 661-396-1169
  • Fax: 661-397-6188
Mailing address:
  • Phone: 661-396-1169
  • Fax: 661-397-6188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number44530
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: