Healthcare Provider Details

I. General information

NPI: 1245755768
Provider Name (Legal Business Name): ANNIE THAI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST
LOS ANGELES CA
90033-1029
US

IV. Provider business mailing address

1200 N STATE ST
LOS ANGELES CA
90033-1029
US

V. Phone/Fax

Practice location:
  • Phone: 626-537-5445
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number37242
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: