Provider Demographics
NPI:1518029651
Name:HO, HUY THANH (DMD)
Entity type:Individual
Prefix:DR
First Name:HUY
Middle Name:THANH
Last Name:HO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4276 54TH PL
Mailing Address - Street 2:SUITE #D
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-6011
Mailing Address - Country:US
Mailing Address - Phone:619-265-0566
Mailing Address - Fax:619-265-0568
Practice Address - Street 1:4276 54TH PL
Practice Address - Street 2:SUITE #D
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-6011
Practice Address - Country:US
Practice Address - Phone:619-265-0566
Practice Address - Fax:619-265-0568
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA470891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice