1669481610 NPI number — DR. THAN TUN OO MB.B.S., D.O

Table of content: DR. THAN TUN OO MB.B.S., D.O (NPI 1669481610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669481610 NPI number — DR. THAN TUN OO MB.B.S., D.O

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OO
Provider First Name:
THAN
Provider Middle Name:
TUN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MB.B.S., D.O
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OO
Provider Other First Name:
ERNEST
Provider Other Middle Name:
THAN TUN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.B.B.S., D.O
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1669481610
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
TURNER STREET, FAGATOGO
Provider Second Line Business Mailing Address:
LBJ TROPICAL MEDICAL CENTER
Provider Business Mailing Address City Name:
PAGO PAGO AMERICAN SAMOA
Provider Business Mailing Address State Name:
AS
Provider Business Mailing Address Postal Code:
96799-1684
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
684-633-1222
Provider Business Mailing Address Fax Number:
684-633-5913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
TURNER STREET, FAGATOGO
Provider Second Line Business Practice Location Address:
LBJ TROPICAL MEDICAL CENTER
Provider Business Practice Location Address City Name:
PAGO PAGO AMERICAN SAMOA
Provider Business Practice Location Address State Name:
AS
Provider Business Practice Location Address Postal Code:
96799-1684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
684-633-1222
Provider Business Practice Location Address Fax Number:
684-633-5913
Provider Enumeration Date:
08/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  3063-C , registered in the state of AS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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