Provider Demographics
NPI:1104130541
Name:THAI, KHOAN (MD)
Entity type:Individual
Prefix:DR
First Name:KHOAN
Middle Name:
Last Name:THAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 PRESSLER ST UNIT 1476
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3722
Mailing Address - Country:US
Mailing Address - Phone:713-792-4487
Mailing Address - Fax:713-745-1151
Practice Address - Street 1:1400 PRESSLER ST UNIT 1476
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3722
Practice Address - Country:US
Practice Address - Phone:713-792-4487
Practice Address - Fax:860-545-5646
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT617792085R0202X
PAMT211571207R00000X
VA0110003559363A00000X
390200000X
TXBP100774112085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program