Provider Demographics
NPI:1821058249
Name:MOKHTEE, LINH THAI (PA)
Entity Type:Individual
Prefix:
First Name:LINH
Middle Name:THAI
Last Name:MOKHTEE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LINH
Other - Middle Name:
Other - Last Name:THAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6600 S YALE AVE STE 1400
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3331
Mailing Address - Country:US
Mailing Address - Phone:918-499-4855
Mailing Address - Fax:
Practice Address - Street 1:1801 E KENOSHA ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-2098
Practice Address - Country:US
Practice Address - Phone:918-449-4150
Practice Address - Fax:918-449-4107
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04015363A00000X
OK4694363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ15262Medicare UPIN
TX8G4375Medicare ID - Type Unspecified