1679081848 NPI number — THAYER HUSSEIN DDS,INC

Table of content: (NPI 1679081848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679081848 NPI number — THAYER HUSSEIN DDS,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THAYER HUSSEIN 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:
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:
1679081848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10591 RAMBLEWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STANTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90680-2149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-588-6500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13872 HARBOR BLVD STE 1A-3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDEN GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92843-4041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-265-1000
Provider Business Practice Location Address Fax Number:
714-265-1000
Provider Enumeration Date:
01/22/2018

Additional Information

Authorized Official

Authorized Official Last Name:
HUSSEIN
Authorized Official First Name:
THAYER
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
714-588-6500

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  64043 , 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: 1881030872 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com