Provider Demographics
NPI:1811334741
Name:MEHLERT, THANH NGUYET T (MD)
Entity type:Individual
Prefix:
First Name:THANH NGUYET
Middle Name:T
Last Name:MEHLERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1097 FOXHURST WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-4226
Mailing Address - Country:US
Mailing Address - Phone:408-506-4567
Mailing Address - Fax:408-295-1505
Practice Address - Street 1:1097 FOXHURST WAY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-4226
Practice Address - Country:US
Practice Address - Phone:408-506-4567
Practice Address - Fax:408-295-1505
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-01
Last Update Date:2013-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGFE42344208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice