Provider Demographics
NPI:1679564108
Name:AUNG, SANDA SOE (MD)
Entity Type:Individual
Prefix:
First Name:SANDA
Middle Name:SOE
Last Name:AUNG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2440 MASSACHUSETTS AVE
Mailing Address - Street 2:34
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-1642
Mailing Address - Country:US
Mailing Address - Phone:617-797-7598
Mailing Address - Fax:617-491-1197
Practice Address - Street 1:875 MASSACHUSETTS AVE
Practice Address - Street 2:75
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3067
Practice Address - Country:US
Practice Address - Phone:617-797-9598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2013-08-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2159022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G78731Medicare UPIN