Provider Demographics
NPI:1144055922
Name:THACH, THANH THI LAN
Entity type:Individual
Prefix:
First Name:THANH
Middle Name:THI LAN
Last Name:THACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8591 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-2105
Mailing Address - Country:US
Mailing Address - Phone:657-337-8022
Mailing Address - Fax:
Practice Address - Street 1:8591 BELMONT ST
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-2105
Practice Address - Country:US
Practice Address - Phone:657-337-8022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program