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General NPI Number Information
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NPI Number | 1003578824
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Entity Type | Organization
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Legal Business Name | LIEN KIM QUACH DDS INC
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Dates
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Enumeration Date | 10/08/2021
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Last Update Date | 10/08/2021
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Provider Practice Location Address
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Address Line | 1415 BRUNDAGE LN
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City | BAKERSFIELD
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State | CA
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Zip | 93304-3114
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Country | US
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Telephone | 661-323-0076
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Fax | 661-323-0277
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Provider Business Mailing Address
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Address Line | PO BOX 9579
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City | BAKERSFIELD
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State | CA
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Zip | 93389-9579
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Country | US
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Telephone | 661-323-0076
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Fax | 661-323-0277
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DARU WARDONO
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Credential |
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Telephone | 661-323-0076
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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