Provider Demographics
NPI:1699879114
Name:TON-THAT, QUYNH A (MD)
Entity type:Individual
Prefix:
First Name:QUYNH
Middle Name:A
Last Name:TON-THAT
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 1:17051 NORTH DALLAS PARKWAY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001
Mailing Address - Country:US
Mailing Address - Phone:972-733-3090
Mailing Address - Fax:972-733-4565
Practice Address - Street 1:17051 NORTH DALLAS PARKWAY
Practice Address - Street 2:SUITE 150
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001
Practice Address - Country:US
Practice Address - Phone:972-733-3090
Practice Address - Fax:972-733-4565
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2810207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX045461302Medicaid
TXG88514Medicare UPIN
TX045461302Medicaid