Provider Demographics
NPI:1376712315
Name:HTAIK, TUN TIN (MD)
Entity Type:Individual
Prefix:DR
First Name:TUN
Middle Name:TIN
Last Name:HTAIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 N 15TH ST
Mailing Address - Street 2:MS 989
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1101
Mailing Address - Country:US
Mailing Address - Phone:215-762-4315
Mailing Address - Fax:215-762-4345
Practice Address - Street 1:230 N BROAD STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1102
Practice Address - Country:US
Practice Address - Phone:215-762-4315
Practice Address - Fax:215-762-4345
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD073724L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019674600001Medicaid
PAMD073724LOtherLICENSE
PAMD073724LOtherLICENSE
PAMD073724LOtherLICENSE