Provider Demographics
NPI:1518927821
Name:LEE, THANYA C (MD)
Entity Type:Individual
Prefix:
First Name:THANYA
Middle Name:C
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:THANYA
Other - Middle Name:
Other - Last Name:CHINAKARN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1490 W SUNSET RD STE 150
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-6655
Mailing Address - Country:US
Mailing Address - Phone:702-566-0333
Mailing Address - Fax:702-566-0315
Practice Address - Street 1:1490 W SUNSET ROAD
Practice Address - Street 2:STE 150, HENDERSON PEDIATRICS
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6655
Practice Address - Country:US
Practice Address - Phone:702-566-0333
Practice Address - Fax:702-566-0315
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11427208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507148Medicaid
NV100506849Medicaid