Healthcare Provider Details

I. General information

NPI: 1548912595
Provider Name (Legal Business Name): THIEN VAN MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2022
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23767 MAUDE LEA ST
NOVI MI
48375-3540
US

IV. Provider business mailing address

23767 MAUDE LEA ST
NOVI MI
48375-3540
US

V. Phone/Fax

Practice location:
  • Phone: 248-787-1862
  • Fax:
Mailing address:
  • Phone: 248-787-1862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. THIEN H VAN
Title or Position: OWNER MEDICAL DIRECTOR
Credential: MD
Phone: 626-255-9311