Provider Demographics
NPI:1689060675
Name:AUNG, BAWK
Entity Type:Individual
Prefix:
First Name:BAWK
Middle Name:
Last Name:AUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 W LARCHMONT LN APT C32
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-4165
Mailing Address - Country:US
Mailing Address - Phone:917-520-9391
Mailing Address - Fax:
Practice Address - Street 1:127 S BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-4006
Practice Address - Country:US
Practice Address - Phone:914-378-7586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program