Healthcare Provider Details

I. General information

NPI: 1255159059
Provider Name (Legal Business Name): MIMI THAI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 SUNSET BLVD #6122
LOS ANGELES CA
90027
US

IV. Provider business mailing address

4950 W SUNSET BLVD # 6122
LOS ANGELES CA
90027-5822
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-8241
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8607
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: