Provider Demographics
NPI:1548424963
Name:AUNG, KYAWT THANDAR (MD)
Entity Type:Individual
Prefix:
First Name:KYAWT
Middle Name:THANDAR
Last Name:AUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19614 58TH AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-2306
Mailing Address - Country:US
Mailing Address - Phone:646-943-1588
Mailing Address - Fax:
Practice Address - Street 1:5223 VAN LOON ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4258
Practice Address - Country:US
Practice Address - Phone:718-424-6741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241558207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03032684Medicaid