Provider Demographics
NPI:1548984669
Name:THUAN THAI, SA-C LLC
Entity type:Organization
Organization Name:THUAN THAI, SA-C LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:THUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:THAI
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA
Authorized Official - Phone:972-408-6019
Mailing Address - Street 1:7750 N MACARTHUR BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-7501
Mailing Address - Country:US
Mailing Address - Phone:972-408-6019
Mailing Address - Fax:
Practice Address - Street 1:7750 N MACARTHUR BLVD STE 120
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-7501
Practice Address - Country:US
Practice Address - Phone:972-408-6019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-03
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty