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General NPI Number Information
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NPI Number | 1467883207
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Entity Type | Individual
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Provider Name | JENNIE QUACH
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Gender | Female
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Dates
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Enumeration Date | 12/04/2013
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Last Update Date | 01/21/2014
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Provider Practice Location Address
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Address Line | 17305 VON KARMAN AVE STE 101-107
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City | IRVINE
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State | CA
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Zip | 92614-0963
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Country | US
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Telephone | 949-679-9994
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Fax |
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Provider Business Mailing Address
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Address Line | 17305 VON KARMAN AVE STE 107
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City | IRVINE
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State | CA
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Zip | 92614-0903
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Country | US
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Telephone | 949-679-9994
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Fax | 949-679-9933
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 51269
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License Number State | CA
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