Provider Demographics
NPI:1275779217
Name:KABZA, THUY LIEN (LMP)
Entity Type:Individual
Prefix:
First Name:THUY
Middle Name:LIEN
Last Name:KABZA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11835 NE STANTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-1764
Mailing Address - Country:US
Mailing Address - Phone:503-419-7602
Mailing Address - Fax:
Practice Address - Street 1:9106 NE HIGHWAY 99
Practice Address - Street 2:H
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8971
Practice Address - Country:US
Practice Address - Phone:503-419-7602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00025395174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist