Provider Demographics
NPI:1215331558
Name:AUNG, THAZIN
Entity type:Individual
Prefix:
First Name:THAZIN
Middle Name:
Last Name:AUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41371 WHITECREST CT
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-4529
Mailing Address - Country:US
Mailing Address - Phone:510-366-2262
Mailing Address - Fax:
Practice Address - Street 1:540 UNIVERSITY AVE
Practice Address - Street 2:STE 110
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-1912
Practice Address - Country:US
Practice Address - Phone:650-321-2015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2020-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15044152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist