MEDICARE: VIVIAN WIN MD

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	207Q00000X	Family Medicine Physician	0101272288	VA
2	207Q00000X	Family Medicine Physician	294849	NY
3	207Q00000X	Family Medicine Physician	A166042	CA

General Provider Information

NPI Number	:	1881088870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIAN WIN MD

Provider Business Mailing Address
First Line	:	11901 SANTA MONICA BLVD # 653
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-2767
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11901 SANTA MONICA BLVD # 653
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-2767
Country	:	US
Telephone Number	:	310-947-3767
Fax Number	:

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

Provider Enumeration Date	:	03/27/2015
Last Update Date	:	01/13/2026

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Directions to “ VIVIAN WIN MD” Practice Location

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