Healthcare Provider Details

I. General information

NPI: 1407388291
Provider Name (Legal Business Name): RICHARD THAI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 W LA PALMA AVE
ANAHEIM CA
92801-2803
US

IV. Provider business mailing address

13089 PEYTON DR # C345
CHINO HILLS CA
91709-6018
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-7890
  • Fax:
Mailing address:
  • Phone: 408-318-5974
  • Fax: 949-362-9503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number20A17017
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number20A17017
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: