Provider Demographics
NPI:1790955300
Name:TA, WILLIAM C (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:TA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KHOI
Other - Middle Name:C
Other - Last Name:TA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1288
Mailing Address - Street 2:
Mailing Address - City:HOOPA
Mailing Address - State:CA
Mailing Address - Zip Code:95546-1288
Mailing Address - Country:US
Mailing Address - Phone:530-625-4261
Mailing Address - Fax:530-625-5171
Practice Address - Street 1:1200 AIRPORT ROAD
Practice Address - Street 2:KIMAW MEDICAL CENTER,
Practice Address - City:HOOPA
Practice Address - State:CA
Practice Address - Zip Code:95546-1288
Practice Address - Country:US
Practice Address - Phone:530-625-4261
Practice Address - Fax:530-625-5171
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA118947208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice