1447403605 NPI number — MRS. LEELEE KHANH-HOA THAMES MD, MBA

Table of content: MRS. LEELEE KHANH-HOA THAMES MD, MBA (NPI 1447403605)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447403605 NPI number — MRS. LEELEE KHANH-HOA THAMES MD, MBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THAMES
Provider First Name:
LEELEE
Provider Middle Name:
KHANH-HOA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD, MBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NGUYEN
Provider Other First Name:
HOA
Provider Other Middle Name:
KHANH
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447403605
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3601 SW RIVER PKWY UNIT 800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97239-4555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-814-4044
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3601 SW RIVER PKWY UNIT 800
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97239-4555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-814-4044
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/30/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  MD156937 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 500646304 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".