1487769113 NPI number — THANH VAN DO, M. D., P. A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487769113 NPI number — THANH VAN DO, M. D., P. A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THANH VAN DO, M. D., P. A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487769113
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21015 CRYSTAL GREENS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KATY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77450-8650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-578-6958
Provider Business Mailing Address Fax Number:
281-599-1506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12121 RICHMOND AVE
Provider Second Line Business Practice Location Address:
SUITE # 216
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77082-2432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-496-1010
Provider Business Practice Location Address Fax Number:
281-599-1506
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DO
Authorized Official First Name:
THANH
Authorized Official Middle Name:
VAN
Authorized Official Title or Position:
PHYSICIAN/DIRECTOR
Authorized Official Telephone Number:
832-578-6958

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  J5087 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1490443-04 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0067KP . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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