Individual provider Active NPI

Elaine Khue Thai, DDS

  • General Practice Dentistry
  • Buena Park, CA
National Provider Identifier
1053965707
Registry record updated Nov 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
104199 Issued in CA
Practice address
7540 Orangethorpe Ave Ste A1
Buena Park, CA 90621-3458
Phone
(714) 576-2540
NPI assigned
Jul 31, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 14, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 104199 CA Primary

Addresses

Primary practice location

7540 Orangethorpe Ave Ste A1
Buena Park, CA 90621-3458

Mailing address

7540 Orangethorpe Ave Ste A1
Buena Park, CA 90621-3458
Phone (714) 576-2540

Other practice location 1

17188 Colima Rd Ste C
Hacienda Heights, CA 91745-6787
Phone (626) 581-7878

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201106002521 CA Order and Referring Only - DentistPractitioner - Dentist 7618387358

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
104199CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Swati Shetty Dental Corporation PastSince Nov 21, 2021 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1564531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636848000000",
    "number": "1053965707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7540 ORANGETHORPE AVE STE A1",
            "city": "BUENA PARK",
            "state": "CA",
            "postal_code": "906213458",
            "telephone_number": "714-576-2540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7540 ORANGETHORPE AVE STE A1",
            "city": "BUENA PARK",
            "state": "CA",
            "postal_code": "906213458",
            "telephone_number": "714-576-2540"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17188 Colima Rd Ste C",
            "address_purpose": "LOCATION",
            "city": "Hacienda Heights",
            "state": "CA",
            "postal_code": "917456787",
            "country_code": "US",
            "telephone_number": "626-581-7878",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THAI",
        "first_name": "ELAINE",
        "middle_name": "KHUE",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-31",
        "last_updated": "2021-11-14",
        "certification_date": "2020-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "104199",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buena Park, CA

Sources for this page

Verify at the official NPI Registry.