Provider Demographics
NPI:1619997467
Name:THAIK, CYNTHIA MO (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:MO
Last Name:THAIK
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 1:2211 W. MAGNOLIA BLVD
Mailing Address - Street 2:STE 140
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-1763
Mailing Address - Country:US
Mailing Address - Phone:818-842-1410
Mailing Address - Fax:818-842-1408
Practice Address - Street 1:2211 W MAGNOLIA BLVD STE 140
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1763
Practice Address - Country:US
Practice Address - Phone:818-842-1410
Practice Address - Fax:818-842-1408
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG82312207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G823120OtherMEDICAL PPIN #
CAW18813Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
CA00G823120OtherMEDICAL PPIN #
CAG40528Medicare UPIN