Provider Demographics
NPI:1710114624
Name:THUKHA, HENRY SOE (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:SOE
Last Name:THUKHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SOE
Other - Middle Name:
Other - Last Name:THUKHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 W 106TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3923
Mailing Address - Country:US
Mailing Address - Phone:212-870-4715
Mailing Address - Fax:
Practice Address - Street 1:120 W 106TH ST
Practice Address - Street 2:JEWISH HOME LIFECARE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3923
Practice Address - Country:US
Practice Address - Phone:212-870-4715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY266101207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program