MEDICARE: DR. OUNG THAIN 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	174400000X	Specialist	MD060716L	PA

General Provider Information

NPI Number	:	1811948409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OUNG THAIN M.D.

Provider Business Mailing Address
First Line	:	1401 LORIMER AVE
Second Line	:
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006-8111
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6420 RISING SUN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-5229
Country	:	US
Telephone Number	:	215-725-7550
Fax Number	:	215-725-1018

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	08/08/2016

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