Provider Demographics
NPI:1477787943
Name:CHU, THANH HAI (DDS)
Entity Type:Individual
Prefix:DR
First Name:THANH
Middle Name:HAI
Last Name:CHU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 MARLBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-4727
Mailing Address - Country:US
Mailing Address - Phone:619-282-7011
Mailing Address - Fax:619-282-1440
Practice Address - Street 1:4403 MARLBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-4727
Practice Address - Country:US
Practice Address - Phone:619-282-7011
Practice Address - Fax:619-282-1440
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA58465122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program