Provider Demographics
NPI:1356425953
Name:CHAU, ANH THU THI (DDS)
Entity type:Individual
Prefix:DR
First Name:ANH THU
Middle Name:THI
Last Name:CHAU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MINOU
Other - Middle Name:A
Other - Last Name:CHAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1403 C ST
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-2331
Mailing Address - Country:US
Mailing Address - Phone:360-835-2178
Mailing Address - Fax:360-835-2626
Practice Address - Street 1:1403 C ST
Practice Address - Street 2:
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671-2331
Practice Address - Country:US
Practice Address - Phone:360-835-2178
Practice Address - Fax:360-835-2626
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000089081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5035126Medicaid
WA801984OtherUNITED CONCORDIA ID#