Mimi Theerathada, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

56371 Issued in CA

Practice address

9972 Bolsa Ave
102
Westminster, CA 92683-6069

Phone

(714) 839-3112

Fax

(714) 839-3223

NPI assigned

Oct 5, 2007

Last updated

Feb 21, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Mimi Theerathada Dental Corporation

  • General Practice Dentistry
  • Westminster, CA
  • NPI 1417483371
  NPD (past) Authorized official

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

{
    "created_epoch": "1191542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487635200000",
    "number": "1528256369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9972 BOLSA AVE",
            "address_2": "102",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "926836069",
            "telephone_number": "714-839-3112",
            "fax_number": "714-839-3223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9972 BOLSA AVE",
            "address_2": "102",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "926836069",
            "telephone_number": "714-839-3112",
            "fax_number": "714-839-3223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEERATHADA",
        "first_name": "MIMI",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-05",
        "last_updated": "2017-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "56371",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "56371",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• THC - Orange County, LLC
• The Bouldin Foundation LLC (The Bouldin Foundation)
• The Family Acupuncturist, Inc.
• The Nguyen Holding (Dba: Bear School)
• The Well Recovery Partners
• Theo Pharmaceuticals Inc (Theo Pharmacy)
• Theresa Pharmacy Inc (2010 Pharmacy)
• Theresa Thanh Ngoc Nguyen, MD, Inc.
• Thien Phuoc Dental Care
• Thien Phuoc Medical Center Inc

• Dentist in Westminster, CA
• Providers in Westminster, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.