Provider Demographics
NPI:1487916367
Name:THEIN, KHIN MA MA (MD)
Entity type:Individual
Prefix:
First Name:KHIN MA MA
Middle Name:
Last Name:THEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13626 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6533
Mailing Address - Country:US
Mailing Address - Phone:718-886-1212
Mailing Address - Fax:
Practice Address - Street 1:13739 45TH AVE
Practice Address - Street 2:CBWCHC
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4094
Practice Address - Country:US
Practice Address - Phone:929-362-3006
Practice Address - Fax:929-362-3026
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY280836207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine