Provider Demographics
NPI:1861475808
Name:THAI, DIVYA (MD)
Entity Type:Individual
Prefix:
First Name:DIVYA
Middle Name:
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 1:3565 DEL AMO BOULEVARD
Mailing Address - Street 2:HEALTHCARE PARTNERS MEDICAL GROUP
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503
Mailing Address - Country:US
Mailing Address - Phone:310-793-4653
Mailing Address - Fax:310-793-0754
Practice Address - Street 1:3565 DEL AMO BLVD
Practice Address - Street 2:HEALTHCARE PARTNERS MEDICAL GROUP
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-1637
Practice Address - Country:US
Practice Address - Phone:310-793-4653
Practice Address - Fax:310-793-0754
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC56165207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02153813Medicaid
G80999Medicare UPIN
NY02153813Medicaid