Provider Demographics
NPI:1134498439
Name:THAN, HAI KIM
Entity Type:Individual
Prefix:
First Name:HAI
Middle Name:KIM
Last Name:THAN
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 1:2799 S WHITE RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-2093
Mailing Address - Country:US
Mailing Address - Phone:408-528-9349
Mailing Address - Fax:408-528-9361
Practice Address - Street 1:2799 S WHITE RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-2093
Practice Address - Country:US
Practice Address - Phone:408-528-9349
Practice Address - Fax:408-528-9361
Is Sole Proprietor?:No
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58711183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist