Provider Demographics
NPI:1740661024
Name:DINH, OANH KIM THI
Entity type:Individual
Prefix:MS
First Name:OANH KIM
Middle Name:THI
Last Name:DINH
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KIM-OANH
Other - Middle Name:THI
Other - Last Name:DINH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5710 BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-5818
Mailing Address - Country:US
Mailing Address - Phone:972-240-7438
Mailing Address - Fax:972-303-3704
Practice Address - Street 1:5710 BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-5818
Practice Address - Country:US
Practice Address - Phone:972-240-7438
Practice Address - Fax:972-303-3704
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist