Provider Demographics
NPI:1750749511
Name:MAUNG, THUYA
Entity type:Individual
Prefix:
First Name:THUYA
Middle Name:
Last Name:MAUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 EASTCHESTER RD APT 4H
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2108
Mailing Address - Country:US
Mailing Address - Phone:646-643-9185
Mailing Address - Fax:
Practice Address - Street 1:500 E SANDFORD BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-4750
Practice Address - Country:US
Practice Address - Phone:914-530-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061378183500000X
NY091827390200000X
MAPI58724390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program