Basic Information
Provider Information | |||||||||
NPI: | 1659553162 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | AUNG | ||||||||
FirstName: | THU HAN | ||||||||
MiddleName: | ARTHUR | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2640 E BARNETT ROAD, #E-333 | ||||||||
Address2: | SOUTHERN OREGON HOSPITALISTS, PC | ||||||||
City: | MEDFORD | ||||||||
State: | OR | ||||||||
PostalCode: | 97504 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5412826770 | ||||||||
FaxNumber: | 5412826771 | ||||||||
Practice Location | |||||||||
Address1: | 2825 E BARNETT ROAD | ||||||||
Address2: | ROGUE VALLEY MEDICAL CENTER | ||||||||
City: | MEDFORD | ||||||||
State: | OR | ||||||||
PostalCode: | 97504 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5417897000 | ||||||||
FaxNumber: | 5138723421 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/27/2007 | ||||||||
LastUpdateDate: | 01/11/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | MD28388 | OR | Y |   | Allopathic & Osteopathic Physicians | Hospitalist |   | 208M00000X | 35-090488 | OH | N |   | Allopathic & Osteopathic Physicians | Hospitalist |   |
ID Information
ID | Type | State | Issuer | Description | 218741 | 05 | OR |   | MEDICAID |