Individual
DR. KIET VI THAI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
643 WASHINGTON AVE, PHILADELPHIA, PA 19147-4825
(215) 462-1290
(215) 462-1105
Mailing address
695 SPROUL RD, BRYN MAWR, PA 19010-1112
(610) 716-1750
(215) 462-1110
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD040810-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001133923-0005
—
PA
01
—
0099262000
PA BLUE SHIELD
PA
01
—
01133923-03
AMERICHOICE
PA
01
—
30001560
KEYSTONE MERCY
PA
01
—
3044617
AETNA
PA
01
—
32884MD040810L
HEALTH PARTNERS
PA
Enumeration date
06/02/2006
Last updated
03/03/2016
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