Healthcare Provider Details

I. General information

NPI: 1255428975
Provider Name (Legal Business Name): HUNG THE QUACH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14382 BROOKHURST ST
GARDEN GROVE CA
92843-4608
US

IV. Provider business mailing address

14382 BROOKHURST ST
GARDEN GROVE CA
92843-4608
US

V. Phone/Fax

Practice location:
  • Phone: 714-839-8770
  • Fax: 714-839-3651
Mailing address:
  • Phone: 714-839-8770
  • Fax: 714-839-3651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA35789
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA35789
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA35789
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: