Provider Demographics
NPI:1245254382
Name:THAI, NICOLE HONG PHUONG (MD)
Entity type:Individual
Prefix:
First Name:NICOLE HONG PHUONG
Middle Name:
Last Name:THAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 JOSE FIGUERES AVE.
Mailing Address - Street 2:SUITE 355
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116
Mailing Address - Country:US
Mailing Address - Phone:408-928-5656
Mailing Address - Fax:408-928-5626
Practice Address - Street 1:200 JOSE FIGUERES AVE
Practice Address - Street 2:SUITE 355
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1500
Practice Address - Country:US
Practice Address - Phone:408-928-5656
Practice Address - Fax:408-928-5626
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA47898207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine