Provider Demographics
NPI:1396064390
Name:HTUN, KHIN T (MD)
Entity type:Individual
Prefix:
First Name:KHIN
Middle Name:T
Last Name:HTUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N 13TH AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-1900
Mailing Address - Country:US
Mailing Address - Phone:909-985-2223
Mailing Address - Fax:909-985-2233
Practice Address - Street 1:600 N 13TH AVE STE 150
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786
Practice Address - Country:US
Practice Address - Phone:909-985-2223
Practice Address - Fax:909-985-2233
Is Sole Proprietor?:No
Enumeration Date:2010-05-31
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111319207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine