Individual
THAN T AYE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6036 OAK FENCE LN, LANCASTER, CA 93536-1794
(909) 967-1872
Mailing address
6036 OAK FENCE LN, LANCASTER, CA 93536-1794
(909) 967-1872
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
550004777
STATE OF CALIFORNIA DEPARTMENT OF PUBLIC HEALTH
CA
Enumeration date
07/28/2019
Last updated
07/28/2019
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