Provider Demographics
NPI:1881789113
Name:MAUNG, TIN MAUNG (DDS)
Entity type:Individual
Prefix:
First Name:TIN
Middle Name:MAUNG
Last Name:MAUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 FERN ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-1521
Mailing Address - Country:US
Mailing Address - Phone:619-236-9549
Mailing Address - Fax:619-234-0311
Practice Address - Street 1:1540 FERN ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-1521
Practice Address - Country:US
Practice Address - Phone:619-236-9549
Practice Address - Fax:619-234-0311
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42743122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist