Provider Demographics
NPI:1598864191
Name:THA, KHIN ZAN (MD)
Entity Type:Individual
Prefix:
First Name:KHIN ZAN
Middle Name:
Last Name:THA
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:PO BOX 636461
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6461
Mailing Address - Country:US
Mailing Address - Phone:440-988-1009
Mailing Address - Fax:440-988-1225
Practice Address - Street 1:1607 STATE RD
Practice Address - Street 2:SUITE 6
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089-9142
Practice Address - Country:US
Practice Address - Phone:440-967-8713
Practice Address - Fax:440-967-1938
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071451T207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9284956OtherMEDICARE GRP
OH0236248Medicaid
OH0878805Medicare PIN
OH0236248Medicaid
OH9284951Medicare PIN