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General NPI Number Information
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NPI Number | 1750329892
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Entity Type | Individual
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Provider Name | KIET VI THAI MD
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Gender | Male
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 03/03/2016
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Provider Practice Location Address
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Address Line | 643 WASHINGTON AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19147-4825
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Country | US
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Telephone | 215-462-1290
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Fax | 215-462-1105
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Provider Business Mailing Address
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Address Line | 695 SPROUL RD
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City | BRYN MAWR
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State | PA
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Zip | 19010-1112
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Country | US
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Telephone | 610-716-1750
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Fax | 215-462-1110
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD040810-L
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License Number State | PA
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