Provider Demographics
NPI:1295737880
Name:THAI, QUANG QUYNH (DDS)
Entity type:Individual
Prefix:DR
First Name:QUANG
Middle Name:QUYNH
Last Name:THAI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-1966
Mailing Address - Country:US
Mailing Address - Phone:818-904-0224
Mailing Address - Fax:
Practice Address - Street 1:7400 VAN NUYS BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-1966
Practice Address - Country:US
Practice Address - Phone:818-904-0224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40991122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist