Provider Demographics
NPI:1851725436
Name:TU, TOM KHIEM (DDS)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:KHIEM
Last Name:TU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:KHIEM
Other - Middle Name:MANH
Other - Last Name:TU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3050 S BRISTOL ST
Mailing Address - Street 2:UNIT 9F
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-6727
Mailing Address - Country:US
Mailing Address - Phone:714-300-4459
Mailing Address - Fax:
Practice Address - Street 1:5017 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-3116
Practice Address - Country:US
Practice Address - Phone:323-268-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62777122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist