Provider Demographics
NPI:1548912595
Name:THIEN VAN MD PLLC
Entity type:Organization
Organization Name:THIEN VAN MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THIEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:VAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-255-9311
Mailing Address - Street 1:23767 MAUDE LEA ST
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-3540
Mailing Address - Country:US
Mailing Address - Phone:248-787-1862
Mailing Address - Fax:
Practice Address - Street 1:23767 MAUDE LEA ST
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-3540
Practice Address - Country:US
Practice Address - Phone:248-787-1862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty