Healthcare Provider Details

I. General information

NPI: 1902426224
Provider Name (Legal Business Name): PING SHI QUACH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PASTEUR DR RM H3591
STANFORD CA
94305-2200
US

IV. Provider business mailing address

300 PASTEUR DR RM H3591
STANFORD CA
94305-2200
US

V. Phone/Fax

Practice location:
  • Phone: 650-725-2181
  • Fax:
Mailing address:
  • Phone: 650-725-2181
  • Fax: 650-725-1216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number34197
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD28951
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01095438A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: