Provider Demographics
NPI:1255789095
Name:THAING, MANITH
Entity type:Individual
Prefix:
First Name:MANITH
Middle Name:
Last Name:THAING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CALLAN AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4523
Mailing Address - Country:US
Mailing Address - Phone:510-213-8297
Mailing Address - Fax:510-547-3258
Practice Address - Street 1:101 CALLAN AVE STE 400
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4523
Practice Address - Country:US
Practice Address - Phone:510-213-8297
Practice Address - Fax:510-547-3258
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator