Healthcare Provider Details

I. General information

NPI: 1487453932
Provider Name (Legal Business Name): THI TRAN QUACH RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6973 LINDA VISTA RD
SAN DIEGO CA
92111-6342
US

IV. Provider business mailing address

6973 LINDA VISTA RD
SAN DIEGO CA
92111-6342
US

V. Phone/Fax

Practice location:
  • Phone: 858-279-9676
  • Fax: 858-279-0377
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number36868
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number98426
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: