Provider Demographics
NPI:1740601814
Name:KIEU, THOMAS (HYGIENIST RDH)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:KIEU
Suffix:
Gender:M
Credentials:HYGIENIST RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 S HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-3005
Mailing Address - Country:US
Mailing Address - Phone:316-681-1530
Mailing Address - Fax:316-682-5231
Practice Address - Street 1:841 S HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-3005
Practice Address - Country:US
Practice Address - Phone:316-681-1530
Practice Address - Fax:316-682-5231
Is Sole Proprietor?:No
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10098124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist