Healthcare Provider Details

I. General information

NPI: 1104870641
Provider Name (Legal Business Name): LE-WAI THANT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 MONTOPOLIS DR
AUSTIN TX
78741-6411
US

IV. Provider business mailing address

2901 MONTOPOLIS DR
AUSTIN TX
78741-6411
US

V. Phone/Fax

Practice location:
  • Phone: 512-978-9901
  • Fax: 512-901-9765
Mailing address:
  • Phone: 512-978-9901
  • Fax: 512-901-9765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK1696
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: