Healthcare Provider Details

I. General information

NPI: 1952211906
Provider Name (Legal Business Name): MATTHEW THANH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2385 E WINDMILL LN
LAS VEGAS NV
89123-2037
US

IV. Provider business mailing address

2385 E WINDMILL LN
LAS VEGAS NV
89123-2037
US

V. Phone/Fax

Practice location:
  • Phone: 702-837-0821
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberIN06008
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: