Provider Demographics
NPI:1710531801
Name:AYE, THAN T
Entity Type:Individual
Prefix:
First Name:THAN
Middle Name:T
Last Name:AYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6036 OAK FENCE LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-1794
Mailing Address - Country:US
Mailing Address - Phone:909-967-1872
Mailing Address - Fax:
Practice Address - Street 1:6036 OAK FENCE LN
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-1794
Practice Address - Country:US
Practice Address - Phone:909-967-1872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-28
Last Update Date:2019-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA550004777OtherSTATE OF CALIFORNIA DEPARTMENT OF PUBLIC HEALTH