Provider Demographics
NPI:1639322688
Name:MINDI THAI, DDS & KIMDUNG TRACY TRAN, DDS, A DENTAL CORPORATION
Entity Type:Organization
Organization Name:MINDI THAI, DDS & KIMDUNG TRACY TRAN, DDS, A DENTAL CORPORATION
Other - Org Name:EDENVALE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MINDI
Authorized Official - Middle Name:CHAU
Authorized Official - Last Name:THAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-225-5883
Mailing Address - Street 1:120 BLOSSOM HILL RD
Mailing Address - Street 2:SUITE 20
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-2302
Mailing Address - Country:US
Mailing Address - Phone:408-225-5883
Mailing Address - Fax:408-225-8650
Practice Address - Street 1:120 BLOSSOM HILL RD
Practice Address - Street 2:SUITE 20
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-2302
Practice Address - Country:US
Practice Address - Phone:408-225-5883
Practice Address - Fax:408-225-8650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA490101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty