Provider Demographics
NPI:1457030553
Name:THONG, SANDRA MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:MARIE
Last Name:THONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 N OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-1339
Mailing Address - Country:US
Mailing Address - Phone:626-320-2542
Mailing Address - Fax:
Practice Address - Street 1:1000 E WASHINGTON BLVD STE 112
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90021-3070
Practice Address - Country:US
Practice Address - Phone:213-973-5180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2025-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1088961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice