Provider Demographics
NPI:1619937877
Name:VAN, THOMAS H (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:H
Last Name:VAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:THINH
Other - Middle Name:H
Other - Last Name:VAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:440 E HUNTINGTON DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3776
Mailing Address - Country:US
Mailing Address - Phone:626-254-8246
Mailing Address - Fax:626-254-8236
Practice Address - Street 1:2600 REDONDO AVE
Practice Address - Street 2:303
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2329
Practice Address - Country:US
Practice Address - Phone:562-988-7000
Practice Address - Fax:562-988-7201
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA061189207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA692068Medicare UPIN