Provider Demographics
NPI:1750329892
Name:THAI, KIET VI (MD)
Entity Type:Individual
Prefix:DR
First Name:KIET
Middle Name:VI
Last Name:THAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 SPROUL RD
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1112
Mailing Address - Country:US
Mailing Address - Phone:610-716-1750
Mailing Address - Fax:215-462-1110
Practice Address - Street 1:643 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-4825
Practice Address - Country:US
Practice Address - Phone:215-462-1290
Practice Address - Fax:215-462-1105
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040810-L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30001560OtherKEYSTONE MERCY
PA0099262000OtherPA BLUE SHIELD
PA01133923-03OtherAMERICHOICE
PA001133923-0005Medicaid
PA32884MD040810LOtherHEALTH PARTNERS
PA3044617OtherAETNA
C33821Medicare UPIN