Healthcare Provider Details

I. General information

NPI: 1811834526
Provider Name (Legal Business Name): VALERIE HOANG THAI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 LINCOLN BLVD
VENICE CA
90291-2842
US

IV. Provider business mailing address

12411 W FIELDING CIR APT 5323
PLAYA VISTA CA
90094-2650
US

V. Phone/Fax

Practice location:
  • Phone: 310-392-4103
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number112675
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: