Healthcare Provider Details

I. General information

NPI: 1063100725
Provider Name (Legal Business Name): JENNY THAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2023
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 LOMITA BLVD STE 300
TORRANCE CA
90505-5038
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-257-0028
  • Fax: 310-257-0031
Mailing address:
  • Phone: 310-257-0028
  • Fax: 310-257-0031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA197373
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: