Provider Demographics
NPI:1073625232
Name:DIEUMY MICHELLE THAI, MD, INC.
Entity Type:Organization
Organization Name:DIEUMY MICHELLE THAI, MD, INC.
Other - Org Name:TOTAL REHAB & HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:THAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-596-4288
Mailing Address - Street 1:16401 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-7827
Mailing Address - Country:US
Mailing Address - Phone:714-596-4288
Mailing Address - Fax:714-596-2388
Practice Address - Street 1:16401 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-7827
Practice Address - Country:US
Practice Address - Phone:714-596-4288
Practice Address - Fax:714-596-2388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG644010208100000X, 2081P0004X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G644010Medicaid
CAG64401Medicare ID - Type Unspecified
CA00G644010Medicaid