Provider Demographics
NPI:1144595190
Name:HTWAY, THI THI (MD)
Entity Type:Individual
Prefix:DR
First Name:THI
Middle Name:THI
Last Name:HTWAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:THI THI
Other - Middle Name:
Other - Last Name:HTWAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6330 RUGBY AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6330 RUGBY AVE
Practice Address - Street 2:STE 200
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255
Practice Address - Country:US
Practice Address - Phone:323-277-7678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA124928207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine