Provider Demographics
NPI:1275762569
Name:THAI, CHRISTY HA (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:HA
Last Name:THAI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 WALNUT GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1654
Mailing Address - Country:US
Mailing Address - Phone:626-831-2363
Mailing Address - Fax:
Practice Address - Street 1:11135 183RD ST
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-5415
Practice Address - Country:US
Practice Address - Phone:562-804-2296
Practice Address - Fax:562-860-8643
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA475711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice