Individual
JACKIE LEE QUACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1040 DELAWARE AVE, MARION, OH 43302-6416
(740) 383-8090
(740) 375-6481
Mailing address
# L-3652, COLUMBUS, OH 43260-6453
(740) 383-7927
(740) 383-7942
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
35.121203
OH
208000000X
Pediatrics Physician
A119861
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0087085
—
OH
Enumeration date
09/28/2012
Last updated
12/15/2021
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