Healthcare Provider Details

I. General information

NPI: 1639296700
Provider Name (Legal Business Name): KHINE WIN PHYU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10418 VALLEY BLVD ALTAMED SBC PACE -EL MONTE
EL MONTE CA
91731-3600
US

IV. Provider business mailing address

10418 VALLEY BLVD ALTAMED SBC PACE -EL MONTE
EL MONTE CA
91731-3600
US

V. Phone/Fax

Practice location:
  • Phone: 626-258-1600
  • Fax: 626-258-1609
Mailing address:
  • Phone: 626-258-1600
  • Fax: 626-258-1609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number12471
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number12471
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: