Provider Demographics
NPI:1639270275
Name:THAI, DIEUMY (MD)
Entity Type:Individual
Prefix:DR
First Name:DIEUMY
Middle Name:
Last Name:THAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:D. MICHELLE
Other - Middle Name:
Other - Last Name:THAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 9015
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92728-9015
Mailing Address - Country:US
Mailing Address - Phone:714-596-4288
Mailing Address - Fax:714-596-2388
Practice Address - Street 1:16401 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-7827
Practice Address - Country:US
Practice Address - Phone:714-596-4288
Practice Address - Fax:714-596-2388
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64401208100000X, 2081P0004X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G644010Medicaid
CA00G644010Medicaid
CAF03135Medicare UPIN