Provider Demographics
NPI:1689098162
Name:HA, THANH THI THU (DO)
Entity Type:Individual
Prefix:
First Name:THANH
Middle Name:THI THU
Last Name:HA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11500 BROOKSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-4917
Mailing Address - Country:US
Mailing Address - Phone:510-209-8382
Mailing Address - Fax:
Practice Address - Street 1:11500 BROOKSHIRE AVE
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4917
Practice Address - Country:US
Practice Address - Phone:510-209-8382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A13089207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine