Healthcare Provider Details

I. General information

NPI: 1982358024
Provider Name (Legal Business Name): LIEN KIM QUACH DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 02/08/2022
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 HASTI ACRES DR STE 9
BAKERSFIELD CA
93309-4879
US

IV. Provider business mailing address

PO BOX 10600
BAKERSFIELD CA
93389-0600
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 Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

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