Provider Demographics
NPI:1366431413
Name:DO, THU SONG (DDS)
Entity type:Individual
Prefix:DR
First Name:THU
Middle Name:SONG
Last Name:DO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 W WHITTIER BLVD.
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-3661
Mailing Address - Country:US
Mailing Address - Phone:562-694-8861
Mailing Address - Fax:562-694-8961
Practice Address - Street 1:1930 W WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-3661
Practice Address - Country:US
Practice Address - Phone:562-694-8861
Practice Address - Fax:562-694-8961
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA478771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice