Provider Demographics
NPI:1205902301
Name:TON-THAT, CHAU (DO)
Entity type:Individual
Prefix:DR
First Name:CHAU
Middle Name:
Last Name:TON-THAT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4131 COSTERO RISCO
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6408
Mailing Address - Country:US
Mailing Address - Phone:949-699-3445
Mailing Address - Fax:949-218-8173
Practice Address - Street 1:9533 BOLSA AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5904
Practice Address - Country:US
Practice Address - Phone:714-531-8720
Practice Address - Fax:714-531-5794
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A71772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX71770Medicaid
CAW21125Medicare PIN
CA00AX71770Medicaid