Individual
THAY KIEU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
30035 HAUN RD, MENIFEE, CA 92584
(951) 566-9090
Mailing address
30035 HAUN RD, MENIFEE, CA 92584-6805
(951) 566-9090
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
24963
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
24963
—
CA
Enumeration date
12/19/2016
Last updated
02/09/2017
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