Healthcare Provider Details

I. General information

NPI: 1235560327
Provider Name (Legal Business Name): MICHAEL THAI, DDS, APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2013
Last Update Date: 12/01/2024
Certification Date: 12/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 S 1ST AVE
ARCADIA CA
91006-7529
US

IV. Provider business mailing address

823 S 1ST AVE
ARCADIA CA
91006-7529
US

V. Phone/Fax

Practice location:
  • Phone: 626-540-2899
  • Fax:
Mailing address:
  • Phone: 626-540-2899
  • Fax: 626-540-2822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number50001
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number51153
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL DON THAI
Title or Position: OWNER
Credential: DDS
Phone: 626-540-2899