Basic Information
| Provider Information | |||||||||
| NPI: | 1457831372 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THANT | ||||||||
| FirstName: | AYE | ||||||||
| MiddleName: | AYE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1141 HARBOR BAY PKWY STE 105 | ||||||||
| Address2: | |||||||||
| City: | ALAMEDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945026596 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108352777 | ||||||||
| FaxNumber: | 5108350164 | ||||||||
| Practice Location | |||||||||
| Address1: | 1141 HARBOR BAY PKWY STE 105 | ||||||||
| Address2: | |||||||||
| City: | ALAMEDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945026596 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108352777 | ||||||||
| FaxNumber: | 5108350164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2018 | ||||||||
| LastUpdateDate: | 08/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | Y | Other Service Providers | Community Health Worker |
No ID Information.