Provider Demographics
NPI:1831344241
Name:AU, WAI MUN
Entity type:Individual
Prefix:MRS
First Name:WAI
Middle Name:MUN
Last Name:AU
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MYRA
Other - Middle Name:
Other - Last Name:MAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1231 CHESTNUT ST.
Mailing Address - Street 2:#128
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107
Mailing Address - Country:US
Mailing Address - Phone:267-255-4039
Mailing Address - Fax:
Practice Address - Street 1:1231 CHESTNUT ST.
Practice Address - Street 2:#128
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:267-255-4039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207881225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA207881Medicaid