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General NPI Number Information
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NPI Number | 1679739148
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Entity Type | Individual
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Provider Name | THANH SON THAI MD
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Gender | Male
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Dates
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Enumeration Date | 08/04/2008
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Last Update Date | 02/07/2022
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Provider Practice Location Address
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Address Line | 137 N OAK PARK AVE STE 209
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City | OAK PARK
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State | IL
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Zip | 60301-1340
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Country | US
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Telephone | 872-216-2227
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Fax | 872-228-8006
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Provider Business Mailing Address
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Address Line | 137 N OAK PARK AVE STE 209
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City | OAK PARK
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State | IL
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Zip | 60301-1340
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Country | US
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Telephone | 872-216-2227
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Fax | 872-228-8006
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036123833
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License Number State | IL
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