Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Justin Thai Thach, PA

Individual provider Surgical Physician Assistant · NPI 1558558395

Justin Thai Thach, PA is a Surgical Physician Assistant in College Point, New York. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2007
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1217 119th St
College Point, NY 11356-1648
Phone: (646) 898-7446
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence 012085 (NY)

Record details

NPI number1558558395
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorYes
NPI enumeratedSeptember 25, 2007
Last updated in NPPESDecember 9, 2015