Provider Demographics
NPI:1639379894
Name:THY, MUYHONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:MUYHONG
Middle Name:
Last Name:THY
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 1:2150 APPIAN WAY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2583
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2150 APPIAN WAY
Practice Address - Street 2:SUITE 205
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2583
Practice Address - Country:US
Practice Address - Phone:510-724-5363
Practice Address - Fax:510-724-5391
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55868122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist