Provider Demographics
NPI:1215469952
Name:THAI, TAM K (MCA)
Entity type:Individual
Prefix:
First Name:TAM
Middle Name:K
Last Name:THAI
Suffix:
Gender:M
Credentials:MCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2618 HWY 36-SOUTH
Mailing Address - Street 2:BLUEBONNET CENTER
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-1909
Mailing Address - Country:US
Mailing Address - Phone:979-830-9111
Mailing Address - Fax:
Practice Address - Street 1:2618 HWY 36-SOUTH
Practice Address - Street 2:BLUEBONNET CENTER
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-1909
Practice Address - Country:US
Practice Address - Phone:979-830-9111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00153171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist