MEDICARE: DR. ANDREW THUC DO D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	B45851	CA

General Provider Information

NPI Number	:	1326144718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW THUC DO D.D.S.

Provider Business Mailing Address
First Line	:	904 ABBOT AVE
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-2309
Country	:	US
Telephone Number	:	626-284-2558
Fax Number	:	626-573-3210

Provider Business Practice Location Address
First Line	:	625 E VALLEY BLVD
Second Line	:	#K
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-3591
Country	:	US
Telephone Number	:	626-573-3261
Fax Number	:	626-573-3210

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	07/08/2007

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