Healthcare Provider Details

I. General information

NPI: 1043134398
Provider Name (Legal Business Name): KYAW LWIN OO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S GARFIELD AVE STE 203
MONTEREY PARK CA
91754-3395
US

IV. Provider business mailing address

11934 FAIRVIEW ST
EL MONTE CA
91732-1434
US

V. Phone/Fax

Practice location:
  • Phone: 626-573-2700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113506
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: