Healthcare Provider Details

I. General information

NPI: 1083177182
Provider Name (Legal Business Name): THA AUNG SAW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 112TH AVE NE STE 320
BELLEVUE WA
98004-4511
US

IV. Provider business mailing address

1035 116TH AVE NE
BELLEVUE WA
98004-4604
US

V. Phone/Fax

Practice location:
  • Phone: 425-289-3000
  • Fax: 425-289-3240
Mailing address:
  • Phone: 425-289-3000
  • Fax: 425-829-0259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License NumberMD61420652
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberMD61420652
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: