Provider Demographics
NPI:1447400858
Name:THAI, PETER
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:THAI
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 1:34400 FREMONT BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-3322
Mailing Address - Country:US
Mailing Address - Phone:510-790-8088
Mailing Address - Fax:510-790-8098
Practice Address - Street 1:34400 FREMONT BLVD STE C
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94555-3322
Practice Address - Country:US
Practice Address - Phone:510-790-8088
Practice Address - Fax:510-790-8098
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44632122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist