Provider Demographics
NPI:1417228263
Name:CHRISTY H. THAI, D.D.S., INC.
Entity Type:Organization
Organization Name:CHRISTY H. THAI, D.D.S., INC.
Other - Org Name:LAKEWOOD MODERN DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:HA
Authorized Official - Last Name:THAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-920-9050
Mailing Address - Street 1:5507 WOODRUFF AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-1534
Mailing Address - Country:US
Mailing Address - Phone:562-920-9050
Mailing Address - Fax:562-920-9057
Practice Address - Street 1:5507 WOODRUFF AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713-1534
Practice Address - Country:US
Practice Address - Phone:562-920-9050
Practice Address - Fax:562-920-9057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA475711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty