Provider Demographics
NPI:1356426522
Name:THAN, MYANANDI (MD)
Entity type:Individual
Prefix:
First Name:MYANANDI
Middle Name:
Last Name:THAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NANDI
Other - Middle Name:
Other - Last Name:THAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10301 GLACIER HWY
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-8561
Mailing Address - Country:US
Mailing Address - Phone:907-789-2910
Mailing Address - Fax:907-789-5545
Practice Address - Street 1:10301 GLACIER HWY
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8561
Practice Address - Country:US
Practice Address - Phone:907-789-2910
Practice Address - Fax:907-789-5545
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4210207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKH06111Medicare UPIN