Provider Demographics
NPI:1790212496
Name:HO, THIEN THANH (DO)
Entity type:Individual
Prefix:DR
First Name:THIEN
Middle Name:THANH
Last Name:HO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12307 DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-9129
Mailing Address - Country:US
Mailing Address - Phone:831-917-8099
Mailing Address - Fax:
Practice Address - Street 1:12307 DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-9129
Practice Address - Country:US
Practice Address - Phone:831-917-8099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101025360208D00000X
SC353446207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice