Provider Demographics
NPI:1962496588
Name:DINH, KIM-THANH THI (OD)
Entity Type:Individual
Prefix:DR
First Name:KIM-THANH
Middle Name:THI
Last Name:DINH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4288 CHRISTIAN DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135-1182
Mailing Address - Country:US
Mailing Address - Phone:408-499-0140
Mailing Address - Fax:
Practice Address - Street 1:1652 E CAPITOL EXPY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1839
Practice Address - Country:US
Practice Address - Phone:408-528-0991
Practice Address - Fax:408-528-0994
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
CA110500T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0110500Medicaid
CAZZZ24365ZMedicare ID - Type Unspecified
CAZZZ30033ZMedicare ID - Type Unspecified2ND LOCATION
CASD0110500Medicaid