Healthcare Provider Details

I. General information

NPI: 1689208936
Provider Name (Legal Business Name): RACHEL THAI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date: 02/26/2020
Reactivation Date: 04/03/2020

III. Provider practice location address

14305 BASELINE AVE
FONTANA CA
92336-3631
US

IV. Provider business mailing address

26 E LAS FLORES AVE
ARCADIA CA
91006-4632
US

V. Phone/Fax

Practice location:
  • Phone: 909-854-1437
  • Fax:
Mailing address:
  • Phone: 626-552-5708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDDS106495
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: