Healthcare Provider Details

I. General information

NPI: 1083649735
Provider Name (Legal Business Name): KYAW MOE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 SOUTH ST SUITE 101
LAKEWOOD CA
90712-1502
US

IV. Provider business mailing address

3650 SOUTH ST SUITE 101
LAKEWOOD CA
90712-1502
US

V. Phone/Fax

Practice location:
  • Phone: 562-286-6466
  • Fax: 562-286-6465
Mailing address:
  • Phone: 562-286-6466
  • Fax: 562-286-6465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD429546
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA109324
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: