MEDICARE: HUNG THE QUACH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A35789	CA
2	208000000X	Pediatrics Physician	A35789	CA
3	2080N0001X	Neonatal-Perinatal Medicine Physician	A35789	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255428975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUNG THE QUACH M.D.

Provider Business Mailing Address
First Line	:	14382 BROOKHURST ST
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-4608
Country	:	US
Telephone Number	:	714-839-8770
Fax Number	:	714-839-3651

Provider Business Practice Location Address
First Line	:	14382 BROOKHURST ST
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-4608
Country	:	US
Telephone Number	:	714-839-8770
Fax Number	:	714-839-3651

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	12/07/2011

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