Provider Demographics
NPI:1184142341
Name:TA, MINHDAN THUY (PHD)
Entity type:Individual
Prefix:DR
First Name:MINHDAN
Middle Name:THUY
Last Name:TA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11660 CHURCH ST APT 217
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-8930
Mailing Address - Country:US
Mailing Address - Phone:909-764-9795
Mailing Address - Fax:
Practice Address - Street 1:11660 CHURCH ST APT 217
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-8930
Practice Address - Country:US
Practice Address - Phone:909-764-9795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29358103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist