Provider Demographics
NPI:1487769113
Name:THANH VAN DO, M. D., P. A.
Entity type:Organization
Organization Name:THANH VAN DO, M. D., P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THANH
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:832-578-6958
Mailing Address - Street 1:21015 CRYSTAL GREENS DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-8650
Mailing Address - Country:US
Mailing Address - Phone:832-578-6958
Mailing Address - Fax:281-599-1506
Practice Address - Street 1:12121 RICHMOND AVE
Practice Address - Street 2:SUITE # 216
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2432
Practice Address - Country:US
Practice Address - Phone:281-496-1010
Practice Address - Fax:281-599-1506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5087261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1490443-04Medicaid
TX0067KPOtherBLUE CROSS BLUE SHIELD
TX00218WMedicare ID - Type Unspecified
TX1490443-04Medicaid