Provider Demographics
NPI:1063515963
Name:DO, THU TRANG (DO)
Entity type:Individual
Prefix:DR
First Name:THU
Middle Name:TRANG
Last Name:DO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15735 HAWTHORNE BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-2664
Mailing Address - Country:US
Mailing Address - Phone:310-675-1300
Mailing Address - Fax:310-675-1461
Practice Address - Street 1:15735 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-2664
Practice Address - Country:US
Practice Address - Phone:310-213-1453
Practice Address - Fax:310-675-1461
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8885207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX88850Medicaid
CA00AX88850Medicaid
CAW20A8885AMedicare PIN