Healthcare Provider Details

I. General information

NPI: 1639177355
Provider Name (Legal Business Name): SAN SAN WIN M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 12/14/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 POWELL ST
SAN FRANCISCO CA
94133-3849
US

IV. Provider business mailing address

2 N MAYFAIR AVE
DALY CITY CA
94015-1057
US

V. Phone/Fax

Practice location:
  • Phone: 415-292-8650
  • Fax: 415-292-8666
Mailing address:
  • Phone: 650-756-2269
  • Fax: 650-756-2269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberA77815
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: