Provider Demographics
NPI:1124310842
Name:LAN, THANH THIEN HA (MD)
Entity type:Individual
Prefix:DR
First Name:THANH
Middle Name:THIEN HA
Last Name:LAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:THANH
Other - Middle Name:THIEN
Other - Last Name:HA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2225 ENTERPRISE DR STE 2511
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5805
Mailing Address - Country:US
Mailing Address - Phone:708-486-0076
Mailing Address - Fax:
Practice Address - Street 1:960 OLD GREEN BAY RD APT 3N
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-1710
Practice Address - Country:US
Practice Address - Phone:224-247-8870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD222721207ZD0900X
IL125056493207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology