MEDICARE: ELBERT THAN TUN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A111617	CA

General Provider Information

NPI Number	:	1790925774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELBERT THAN TUN M.D.

Provider Business Mailing Address
First Line	:	24324 72ND AVE FL 2
Second Line	:
City	:	LITTLE NECK
State	:	NY
Zip	:	11362-2319
Country	:	US
Telephone Number	:	718-225-2321
Fax Number	:

Provider Business Practice Location Address
First Line	:	24324 72ND AVE FL 2
Second Line	:
City	:	LITTLE NECK
State	:	NY
Zip	:	11362-2319
Country	:	US
Telephone Number	:	718-225-2321
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2009
Last Update Date	:	03/27/2025

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