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General NPI Number Information
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NPI Number | 1376712315
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Entity Type | Individual
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Provider Name | TUN TIN HTAIK MD
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Gender | Male
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Dates
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Enumeration Date | 02/25/2008
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 230 N BROAD STREET
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City | PHILADELPHIA
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State | PA
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Zip | 19102-1102
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Country | US
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Telephone | 215-762-4315
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Fax | 215-762-4345
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Provider Business Mailing Address
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Address Line | 245 N 15TH ST MS 989
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City | PHILADELPHIA
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State | PA
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Zip | 19102-1101
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Country | US
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Telephone | 215-762-4315
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Fax | 215-762-4345
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD073724L
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License Number State | PA
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