Provider Demographics
NPI:1053965707
Name:THAI, ELAINE KHUE (DDS)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:KHUE
Last Name:THAI
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 1:7540 ORANGETHORPE AVE STE A1
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-3458
Mailing Address - Country:US
Mailing Address - Phone:714-576-2540
Mailing Address - Fax:
Practice Address - Street 1:7540 ORANGETHORPE AVE STE A1
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-3458
Practice Address - Country:US
Practice Address - Phone:714-576-2540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2021-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice