1558484527 NPI number — LAN THAI DINH DDS INC

Table of content: (NPI 1558484527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558484527 NPI number — LAN THAI DINH DDS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAN THAI DINH DDS INC
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:
6
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:
1558484527
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2920 S ARCHIBALD AVE
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
ONTARIO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91761-7364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-923-2273
Provider Business Mailing Address Fax Number:
909-923-2284

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2920 S ARCHIBALD AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
ONTARIO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91761-7364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-923-2273
Provider Business Practice Location Address Fax Number:
909-923-2284
Provider Enumeration Date:
04/06/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DINH
Authorized Official First Name:
LAN
Authorized Official Middle Name:
THAI
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
909-923-2273

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  49743 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: G9373301 . This is a "MEDI-CAL PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1114976347 . This is a "PREVIOUS NPI NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".