Healthcare Provider Details

I. General information

NPI: 1912018789
Provider Name (Legal Business Name): THOMAS THAT TON M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7761 GARDEN GROVE BLVD
GARDEN GROVE CA
92841-4200
US

IV. Provider business mailing address

9898 RARITAN AVE
FOUNTAIN VALLEY CA
92708-1047
US

V. Phone/Fax

Practice location:
  • Phone: 714-898-8888
  • Fax: 714-901-7580
Mailing address:
  • Phone: 714-839-1977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG78428
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: