Provider Demographics
NPI:1598819070
Name:THAI, HUNG MINH (DDS)
Entity Type:Individual
Prefix:DR
First Name:HUNG
Middle Name:MINH
Last Name:THAI
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 1:1111 STORY RD
Mailing Address - Street 2:SUITE 1037
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-2663
Mailing Address - Country:US
Mailing Address - Phone:408-999-0480
Mailing Address - Fax:408-288-8212
Practice Address - Street 1:1111 STORY RD
Practice Address - Street 2:SUITE 1037
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-2663
Practice Address - Country:US
Practice Address - Phone:408-999-0480
Practice Address - Fax:408-288-8212
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA445481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice