Provider Demographics
NPI:1376328294
Name:TONTHAT, DYLAN DINH
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:DINH
Last Name:TONTHAT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 KIMBER TER
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-3073
Mailing Address - Country:US
Mailing Address - Phone:510-331-1885
Mailing Address - Fax:
Practice Address - Street 1:381 KIMBER TER
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-3073
Practice Address - Country:US
Practice Address - Phone:510-331-1885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program