Provider Demographics
NPI:1043952831
Name:DOAN, HIEN THAI
Entity Type:Individual
Prefix:
First Name:HIEN
Middle Name:THAI
Last Name:DOAN
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 1:1801 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-2186
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:91-5431 KAPOLEI PKWY STE 1707
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-5009
Practice Address - Country:US
Practice Address - Phone:414-288-6790
Practice Address - Fax:808-460-7945
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6000071-15122300000X
HIDT-3008122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist