Healthcare Provider Details

I. General information

NPI: 1932779295
Provider Name (Legal Business Name): ALAN QUACH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12611 9TH ST STE B
CHINO CA
91710-3528
US

IV. Provider business mailing address

2108 N ST # 15617
SACRAMENTO CA
95816-5712
US

V. Phone/Fax

Practice location:
  • Phone: 562-252-2243
  • Fax:
Mailing address:
  • Phone: 562-252-2243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA209610
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: