Healthcare Provider Details

I. General information

NPI: 1619558533
Provider Name (Legal Business Name): NANG SAN HTI LAR SENG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 PILGRIM RD
BOSTON MA
02215-5332
US

IV. Provider business mailing address

171 PILGRIM RD # LIBBY2
BOSTON MA
02215-5332
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-9880
  • Fax:
Mailing address:
  • Phone: 617-632-9880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number249081
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: