Provider Demographics
NPI:1669726865
Name:KOMPOR, THIANTHONG (MD)
Entity type:Individual
Prefix:
First Name:THIANTHONG
Middle Name:
Last Name:KOMPOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:THIANTHONG
Other - Middle Name:
Other - Last Name:KOMPOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:THIANTHONG KOMPOR
Mailing Address - Street 1:342 S ORANGE AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91755-7505
Mailing Address - Country:US
Mailing Address - Phone:415-606-1307
Mailing Address - Fax:
Practice Address - Street 1:342 S ORANGE AVE UNIT B
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91755-7505
Practice Address - Country:US
Practice Address - Phone:415-606-1307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0A29375207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherRETIRED