Provider Demographics
NPI:1891764536
Name:THRUN, CAROL J (MD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:THRUN
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 1:4800 S CENTRAL AVE
Mailing Address - Street 2:STE B
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011-5459
Mailing Address - Country:US
Mailing Address - Phone:323-918-2700
Mailing Address - Fax:323-918-2703
Practice Address - Street 1:4800 S CENTRAL AVE
Practice Address - Street 2:STE B
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-5459
Practice Address - Country:US
Practice Address - Phone:323-918-2700
Practice Address - Fax:323-918-2703
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28687208D00000X, 207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA43824Medicare UPIN
CAG28687Medicare ID - Type Unspecified