Provider Demographics
NPI:1760457808
Name:HAN, THEIN HTUN (MD)
Entity Type:Individual
Prefix:MR
First Name:THEIN
Middle Name:HTUN
Last Name:HAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 MAIDEN LANE, 6TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038
Mailing Address - Country:US
Mailing Address - Phone:212-780-2378
Mailing Address - Fax:212-505-0724
Practice Address - Street 1:11401 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-2015
Practice Address - Country:US
Practice Address - Phone:562-521-1152
Practice Address - Fax:562-651-1201
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2307762084P0800X
CAA828812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02678706Medicaid
NYI22971Medicare UPIN
NY122971Medicare UPIN
NY467BY1Medicare ID - Type Unspecified