Healthcare Provider Details

I. General information

NPI: 1255603098
Provider Name (Legal Business Name): TRUNG M THAI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 DOVE ST SUITE 299
NEWPORT BEACH CA
92660-2433
US

IV. Provider business mailing address

1601 DOVE ST SUITE 299
NEWPORT BEACH CA
92660-2433
US

V. Phone/Fax

Practice location:
  • Phone: 949-851-3086
  • Fax: 949-398-8072
Mailing address:
  • Phone: 949-851-3086
  • Fax: 949-398-8072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberA54617
License Number StateCA

VIII. Authorized Official

Name: DR. TRUNG M THAI
Title or Position: OWNER / PSYCHIATRIST
Credential: M.D.
Phone: 949-851-3086