Provider Demographics
NPI:1588857916
Name:THAI, DUNG (MD, PH D)
Entity Type:Individual
Prefix:DR
First Name:DUNG
Middle Name:
Last Name:THAI
Suffix:
Gender:M
Credentials:MD, PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2428 WHIPPLE AVE
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-2150
Mailing Address - Country:US
Mailing Address - Phone:415-225-9338
Mailing Address - Fax:650-216-1569
Practice Address - Street 1:2428 WHIPPLE AVE
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-2150
Practice Address - Country:US
Practice Address - Phone:415-225-9338
Practice Address - Fax:650-216-1569
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76341207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH91255Medicare UPIN