Provider Demographics
NPI:1639670425
Name:HA THI, VAN KHANH (DMD)
Entity Type:Individual
Prefix:MRS
First Name:VAN KHANH
Middle Name:
Last Name:HA THI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 AVENUE ALEMBERT
Mailing Address - Street 2:
Mailing Address - City:ANTONY
Mailing Address - State:ILE DE FRANCE
Mailing Address - Zip Code:92160
Mailing Address - Country:FR
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 ALLEE DU NIL
Practice Address - Street 2:
Practice Address - City:ANTONY
Practice Address - State:ILE DE FRANCE
Practice Address - Zip Code:92160
Practice Address - Country:FR
Practice Address - Phone:014-674-1390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN174521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty