Provider Demographics
NPI:1861594228
Name:HTAY, THEIN (MD)
Entity type:Individual
Prefix:DR
First Name:THEIN
Middle Name:
Last Name:HTAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14633 MOUNTAIN SPRING ST
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-2648
Mailing Address - Country:US
Mailing Address - Phone:626-369-2351
Mailing Address - Fax:626-369-2351
Practice Address - Street 1:35 GARFIELD AVE.
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801
Practice Address - Country:US
Practice Address - Phone:626-458-8818
Practice Address - Fax:626-458-8198
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77109207UN0901X
CAA 77109207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA 77109Medicare ID - Type Unspecified