Healthcare Provider Details

I. General information

NPI: 1093990301
Provider Name (Legal Business Name): LE MINH QUACH B.S./R.D.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2008
Last Update Date: 01/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2664 BERRYESSA RD SUITE 210
SAN JOSE CA
95132-2925
US

IV. Provider business mailing address

2664 BERRYESSA RD SUITE 210
SAN JOSE CA
95132-2925
US

V. Phone/Fax

Practice location:
  • Phone: 408-431-6975
  • Fax: 408-258-8838
Mailing address:
  • Phone: 408-431-6975
  • Fax: 408-258-8838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number22109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: