Provider Demographics
NPI:1568094118
Name:KHAING THEIN, MIN
Entity Type:Individual
Prefix:
First Name:MIN
Middle Name:
Last Name:KHAING THEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 INTERNATIONAL BLVD APT 9
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-2973
Mailing Address - Country:US
Mailing Address - Phone:510-444-1671
Mailing Address - Fax:510-444-4283
Practice Address - Street 1:544 INTERNATIONAL BLVD APT 9
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-2973
Practice Address - Country:US
Practice Address - Phone:510-444-1671
Practice Address - Fax:510-444-4283
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker