Provider Demographics
NPI:1790524387
Name:KIEU, NGOC THAI
Entity type:Individual
Prefix:
First Name:NGOC THAI
Middle Name:
Last Name:KIEU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 AFFINITY LN, APT 249C
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215
Mailing Address - Country:US
Mailing Address - Phone:928-458-8070
Mailing Address - Fax:
Practice Address - Street 1:2157 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214
Practice Address - Country:US
Practice Address - Phone:716-862-1423
Practice Address - Fax:716-862-1871
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2025-02-04
Deactivation Date:2025-01-14
Deactivation Code:
Reactivation Date:2025-02-04
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program