Provider Demographics
NPI:1568705481
Name:LONG THAO, M.D. INC.
Entity type:Organization
Organization Name:LONG THAO, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SENG
Authorized Official - Middle Name:
Authorized Official - Last Name:THAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-384-8426
Mailing Address - Street 1:700 W OLIVE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-2435
Mailing Address - Country:US
Mailing Address - Phone:209-384-8426
Mailing Address - Fax:209-384-8015
Practice Address - Street 1:700 W OLIVE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2435
Practice Address - Country:US
Practice Address - Phone:209-384-8426
Practice Address - Fax:209-384-8015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66867207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty