Provider Demographics
NPI:1255489811
Name:LA, THAI KIEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:THAI
Middle Name:KIEN
Last Name:LA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14401B CHEF MENTEUR HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70129-2014
Mailing Address - Country:US
Mailing Address - Phone:504-254-4900
Mailing Address - Fax:504-254-6080
Practice Address - Street 1:14401B CHEF MENTEUR HWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70129-2014
Practice Address - Country:US
Practice Address - Phone:504-254-4900
Practice Address - Fax:504-254-6080
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA53381223G0001X
FLDN174751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1853381Medicaid