Healthcare Provider Details

I. General information

NPI: 1124436001
Provider Name (Legal Business Name): LEI THANDAR WIN M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 04/18/2026
Certification Date: 04/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3780 KILROY AIRPORT WAY STE 115
LONG BEACH CA
90806-2458
US

IV. Provider business mailing address

3780 KILROY AIRPORT WAY # 115
LONG BEACH CA
90806-2457
US

V. Phone/Fax

Practice location:
  • Phone: 650-303-1246
  • Fax:
Mailing address:
  • Phone: 562-595-7426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA145310
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA145310
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: