Individual
KHIN ZAN THA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1607 STATE RD, SUITE 6, VERMILION, OH 44089-9142
(440) 967-8713
(440) 967-1938
Mailing address
PO BOX 636461, CINCINNATI, OH 45263-6461
(440) 988-1009
(440) 988-1225
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35071451T
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0236248
—
OH
01
—
9284956
MEDICARE GRP
OH
Enumeration date
09/21/2006
Last updated
12/14/2009
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