Healthcare Provider Details

I. General information

NPI: 1578653515
Provider Name (Legal Business Name): KHIN MAUNG AYE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 09/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 KING AVE
CORCORAN CA
93212-9611
US

IV. Provider business mailing address

4001 KING AVE
CORCORAN CA
93212-9611
US

V. Phone/Fax

Practice location:
  • Phone: 559-992-8800
  • Fax:
Mailing address:
  • Phone: 559-992-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA76549
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: