Provider Demographics
NPI:1104044486
Name:LATT, KHIN M (MD)
Entity Type:Individual
Prefix:
First Name:KHIN
Middle Name:M
Last Name:LATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:11 SHIELDS CT
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11719-9309
Mailing Address - Country:US
Mailing Address - Phone:631-286-6124
Mailing Address - Fax:631-286-6124
Practice Address - Street 1:14 GLOVER DR
Practice Address - Street 2:
Practice Address - City:YAPHANK
Practice Address - State:NY
Practice Address - Zip Code:11980-1204
Practice Address - Country:US
Practice Address - Phone:631-852-4400
Practice Address - Fax:631-852-4414
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY102875-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00623872Medicaid
576601Medicare ID - Type Unspecified
NY00623872Medicaid