Provider Demographics
NPI:1376659565
Name:DO, THU NGOC (MD)
Entity Type:Individual
Prefix:
First Name:THU
Middle Name:NGOC
Last Name:DO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4712 EL CAJON BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-4557
Mailing Address - Country:US
Mailing Address - Phone:619-563-0724
Mailing Address - Fax:619-563-5287
Practice Address - Street 1:4712 EL CAJON BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-4557
Practice Address - Country:US
Practice Address - Phone:619-563-0724
Practice Address - Fax:619-563-5287
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38325174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A383250Medicaid
CAA38325Medicare ID - Type UnspecifiedPROVIDER IDENTIFICATION #
CA00A383250Medicaid